Coronary Artery Spasm, Coronary Reactivity, and Their Psychological Context

Abstract

Symptomatic individuals suspected of having myocardial ischemia often have no obstructive atherosclerotic narrowing of epicardial coronary arteries. Abnormal coronary vascular reactivity, and in particular, coronary artery vasospasm (CAS), may be an explanation in a subset of these patients. Psychological factors play an important role in ischemic heart disease, but their role in CAS is not clear; autonomic dysfunction and increased inflammation are two prevailing pathophysiological mechanisms implicated in abnormal coronary reactivity resulting from mental health conditions. Interrelationships between psychological factors, abnormal coronary reactivity, and sex/gender differences are poorly defined in the etiology of CAS. In this issue of Psychosomatic Medicine, Hung et al. report a frequency of less than 0.1% of new onset CAS in the Taiwanese population, with higher occurrence in women and younger individuals. Patients with CAS had a higher prevalence of prior anxiety and depression compared to those with coronary artery disease and controls, with no sex differences. In this editorial comment, we discuss the potential reasons for underreporting of CAS and the challenges regarding the use of administrative health records for psychosomatic research. In this editorial, a model is presented to explain the association between emotional stressors and mental health factors with CAS, including the role of sympathetic nervous system activation, inflammation, oxidative stress, endothelial dysfunction, and smooth muscle cell dysregulation.

Low socioeconomic status and depression: A double jeopardy for cardiovascular disease?

“…We should, however, also recognize limitations in this study inherent with using health insurance claims data, which have been previously pointed out [16]. Some of these are acknowledged by the authors (misclassification, unmeasured confounding, residual confounding) and may have biased results towards the null given that the effect sizes for AMI and stroke were quite small.…”

Perioperative coronary artery spasm after off-pump coronary artery bypass grafting in the non-manipulated coronary artery

“…To date, the etiology of CAS following CABG is still not well defined. Some postoperative factors are reported to affect the CAS, including vascular trauma, platelet activation, high local potassium [ 1 , 19 ]. The occurrence of CAS showed no specific sites, such as a site of mild or severe stenosis, or any segment of the coronary arteries with no structural anomaly.…”

Coronary vasospasm-induced syncope with dynamic changes of regional wall motion abnormalities confirmed real-time: a case report

“…However, it is understood to be caused by impaired vasodilation secondary to smooth muscle hyperactivity and endothelial, autonomic, and microvascular dysfunctions due to the traditional risk factors of coronary artery disease. 6 , 7 Since the episodes of coronary vasospasm are usually temporary, establishing a definite diagnosis of VSA is challenging. However, if VSA is suspected clinically, a provocation test is needed for a precise diagnosis.…”