Chronic stable angina clinical subset- vasospastic angina
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Chronic stable angina Microchapters | ||
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Differentiating Chronic Stable Angina from Acute Coronary Syndromes | ||
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Alternative Therapies for Refractory Angina | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S.
Synonyms and related keywords: vasospastic angina, variant angina, prinzmetal's angina
Overview
- Coronary artery spasm due hyperreactivity of the involved smooth muscle cells is considered to be the underlying mechanism responsible for variant angina.
- A significant group of patients with variant angina have obstructive coronary artery disease.[1]
- Precipitating factors for vasospasm are:
- cold stimulation
- smoking
- cocaine use
- electrolyte disturbances (potassium, magnesium)
- autoimmune diseases
- hyperventilation
- insulin resistance
- higher prevalence in Japanese populations.
- ST elevation is classically observed on ECG during an episode of vasospasm.
- Intracoronary acetylcholine or ergonovine provocation test is used to diagnose vasospasm.
- The prognosis of vasospastic angina depends on the extent of underlying CAD.
ESC Guidelines for diagnostic tests in suspected vasospastic angina (DO NOT EDIT)[2]
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Class I1. ECG during angina if possible. (Level of Evidence: B) 2. Coronary arteriography in patients with characteristic episodic chest pain and ST-segment changes that resolve with nitrates and/or calcium channel blockers to determine the extent of underlying coronary disease. (Level of Evidence: B) Class IIa1. Intracoronary provocative testing to identify coronary spasm in patients with normal findings or nonobstructive lesions on coronary arteriography and the clinical picture of coronary spasm. (Level of Evidence: B) 2. Ambulatory ST Segment Monitoring to identify ST-deviation. (Level of Evidence: C) |
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ESC Guidelines for pharmacological therapy of vasospastic angina (DO NOT EDIT)[2]
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Class I1. Treatment with calcium channel blocker and if necessary nitrates in patients whose coronary arteriogram is normal or shows only non-obstructive lesions. (Level of Evidence: B) |
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Sources
- Guidelines on the management of stable angina pectoris: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology [2]
References
- ↑ Maseri A, Severi S, Nes MD, L'Abbate A, Chierchia S, Marzilli M et al. (1978) "Variant" angina: one aspect of a continuous spectrum of vasospastic myocardial ischemia. Pathogenetic mechanisms, estimated incidence and clinical and coronary arteriographic findings in 138 patients. Am J Cardiol 42 (6):1019-35. PMID: 727129
- ↑ 2.0 2.1 2.2 Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F; et al. (2006). "Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology". Eur Heart J. 27 (11): 1341–81. doi:10.1093/eurheartj/ehl001. PMID 16735367.