Management of Coronary Spasms
Management of coronary spasm (vasospastic angina) includes the following to reduce the frequency of episodes and the severity of complications:
- Alteration in lifestyle: smoking cessation
- Calcium channel blockers to prevent vasoconstriction in the coronary arteries, which reduces the pain
- Long-acting vasodilators (long-acting nitrates)
- Statins that, besides their efficacy in treating dyslipidemia, directly enhance endothelial nitric oxide for vasodilation and affect vascular smooth muscle
- Magnesium in cases of magnesium deficiency (hypomagnesemia)
Coronary Artery Spasm Complicated by Heart Disease
For the 25% of vasospasm angina patients who also experience myocardial infarction and serious arrhythmias, therapy for the vasospasm will impact the likelihood of these life-threatening events. Vasospasm is associated with the loosening and release of thrombotic emboli.
Palpitations may indicate an arrhythmia and is associated with syncope or pre-syncope. The type of arrhythmia is dependent on the area that suffers due to compromise of blood flow from the particular coronary artery or arteries. Spasm of the right coronary artery can negatively impact the function of the atrioventricular (AV) node; spasm of the anterior descending coronary artery can result in left ventricular ischemia and subsequent ventricular tachycardia.
Cardiac arrest associated with vasospastic angina should have an implantable cardioverter-defibrillator placed.
A cardioverter-defibrillator should also be used in patients with obstructive coronary artery disease and vasospastic angina who are already on calcium channel blockers.
Percutaneous coronary intervention (PCI) can be helpful if obstructive coronary disease is responsible for triggering vasospastic angina. Stenting, or if multi-vessel disease is present, coronary artery bypass (CABG) may be necessary.