DEAR MAYO CLINIC:

I recently went to the ER with strong chest pain and was told that what I may have experienced was coronary artery spasm. What is this, and does it put me at risk for other heart issues?

ANSWER:

Coronary artery spasm is a brief, temporary narrowing or contraction of an artery that supplies blood to your heart. If the spasm lasts long enough, it can cause symptoms of angina, such as chest tightness or pressure -- or a crushing, squeezing chest pain. It can also trigger a heart attack or life-threatening heart rhythm disturbance (arrhythmia). Repeated episodes of coronary artery spasm can lead to a deterioration of heart function, setting the stage for heart failure.

Although often considered a problem of younger adults, coronary artery spasm can occur in older adults -- particularly older women. In older adults, the problem is more likely to occur in patients who also have atherosclerotic coronary artery disease.

Based on symptoms alone, it can be difficult to distinguish the most common cause of angina -- narrowed arteries due to coronary artery disease -- from angina caused by coronary artery spasm. However, angina caused by coronary artery spasm may be more likely to occur at rest, or may be brought on by certain triggers, such as exposure to cold, tobacco or emotional stress.

Definitive diagnosis of coronary artery spasm often begins with a coronary angiogram that's performed with the expectation of finding atherosclerotic narrowing of a heart artery. However, if no blockages are found as the angiogram is being performed, doctors can administer a drug into your heart arteries that can -- if you're susceptible -- briefly provoke a spasm.

Just because no major narrowing or blockages appear on an angiogram test doesn't mean you're free of coronary artery disease. In fact, coronary artery disease is often present at the site of coronary artery spasm. In the early stages of coronary artery disease, vessel walls undergo almost imperceptible changes and cholesterol-laden plaques initially grow on the wall of an artery, without causing narrowing.

Additional testing may be done to identify endothelial dysfunction, which is commonly associated with coronary artery spasm, especially in older adults. Endothelial dysfunction occurs when the endothelial cells lining the inside of your heart arteries don't perform their function of allowing arteries to properly expand (dilate).

In addition to endothelial dysfunction, the usual factors associated with coronary artery spasm are the same factors that put you at risk of developing atherosclerotic coronary artery disease, such as hypertension, elevated cholesterol and nicotine use.

Additional risk factors for coronary artery spasm are many and include exposure to cold, certain autoimmune diseases such as lupus, migraine, and extreme emotional distress.

The first step in treating coronary artery spasm is to address any underlying causes. For most older adults, this will involve aggressive modification of risk factors for heart disease. This can include not using tobacco products, getting regular exercise, eating a healthy diet, maintaining a healthy weight and managing stress. In addition, your doctor may recommend drugs to help control high blood pressure, cholesterol, diabetes or other risk factors.

Additional drugs prescribed to more directly prevent artery spasm may include:

-- Nitrates, which can help dilate arteries and relax artery walls. These may be prescribed both as a long-term medication and as a pill to have on hand, should an episode occur.

-- Calcium channel blockers, which help relax artery muscles. These are taken long term.

-- The supplement L-arginine. This helps increase nitric oxide activity, which may prevent spasm.

-- Cholesterol-lowering statin drugs, which can also help improve endothelial function.

Many respond well to these first line measures. However, surgical procedures, such as placing a stent to prop open an area of spasm or implantation of an internal device to stop a life-threatening arrhythmia (defibrillator), may be considered on a case-by-case basis.

Be sure to talk to your doctor about your symptoms and potential treatment options, since coronary artery spasm can lead to life-threatening consequences, such as heart attack and abnormal cardiac rhythms.

 

Amir Lerman, M.D., Cardiovascular Diseases, Mayo Clinic, Rochester, Minn.

Medical Edge from Mayo Clinic is an educational resource and doesn't replace regular medical care.

 

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