Coronary Artery Spasm: Review and Update

Abstract

Coronary artery spasm (CAS), an intense vasoconstriction of coronary arteries that causes total or subtotal vessel occlusion, plays an important role in myocardial ischemic syndromes including stable and unstable angina, acute myocardial infarction, and sudden cardiac death. Coronary angiography and provocative testing usually is required to establish a definitive diagnosis. While the mechanisms underlying the development of CAS are still poorly understood, CAS appears to be a multifactorial disease but is not associated with the traditional risk factors for coronary artery disease. The diagnosis of CAS has important therapeutic implications, as calcium antagonists, not β-blockers, are the cornerstone of medical treatment. The prognosis is generally considered benign; however, recurrent episodes of angina are frequently observed. We provide a review of the literature and summarize the current state of knowledge regarding the pathogenesis of CAS.

Multiple Coronary Artery Aneurysms and Thoracic Aortitis Associated with IgG4-related Disease

“…The inflammation may cause endothelial dysfunction. It leads to a reduction in the release of nitric oxide and the induction of ischemia (16). A previous study reported that endothelial dysfunction in patients with vasculitis improved after the suppression of inflammation (17).…”

Assessment of the Anti-anginal Effect of Tetramethylpyrazine Using Vasopressin-Induced Angina Model Rats

“…7) Intracoronary administration of vasopressin has been shown to constrict small coronary arteries, causing subendocardial ischemia 9) and Ca 2+ channel blocker is known to possess a potent coronary vasodilator effect, which has been widely used for patients with vasospastic angina. 1) Tetramethylpyrazine significantly inhibited the vasopressin-induced subendocardial ischemia, which was not observed by the vehicle, indicating that tetramethylpyrazine may possess an anti-ischemic effect. Similar results were reported previously.…”

“…While β-blockers, Ca 2+ antagonists and/or nitrates have been used for the treatment of patients with angina pectoris according to therapeutic guidances of western medicine, 1) tetramethylpyrazine (TMP), an extract of the herb Ligusticum wallichii FRANCH. (chuanxiong), has been widely applied for the treatment of ischemic heart disease as a complementary and/or alternative medicine in China.…”

New pharmacological strategies in some metabolic endocrine disorder under a toxicological approach

“…In the late 1990s and early 2000s, genetic mutations were found to be associated with CAS. Nonetheless, coronary vascular smooth muscle cell hyper-reactivity seems to constitute the substrate for CAS" [6,7]. Oros P et al, writed that "Sudden death is an important but widely under-recognized consequence of stroke.…”