Prevention of Coronary Spasms
Prevention of increased morbidity or mortality is best accomplished by medical therapy for coronary artery spasm, and the prognosis is best in those who do not have extensive coronary artery disease, multi-vessel involvement, or who use calcium channel blockers.
Medical therapy (calcium channel blockers) is used to prevent:
- Major cardiac events due to coronary stenosis
- Arrhythmias (ventricular fibrillation and sudden cardiac death)
An initial calcium channel blocking agent therapy can be diltiazem at 240-360 mg/day. The dose can be increased if spasm frequency or severity does not respond after an adequate trial.
Other strategies for vasospastic angina, besides calcium channel blockers are:
- Smoking cessation
- Nitroglycerin, which not only aborts anginal symptoms, but may decrease the risk of myocardial infarction or arrhythmias
- Avoidance of beta blockers which can exacerbate vasospasm
The relationship between vasospastic coronary disease and associated myocardial and coronary obstructive disease is strong enough to consider percutaneous coronary interventions to reduce the elevated risks these combined diseases create when present in the same individual.