Coronary artery spasm is a momentary constriction of one of the coronary arteries, the blood vessels which supply blood to the heart. The constriction cuts off the blood supply to the heart, starving it of blood and causing ischemia. Coronary artery spasm may be “silent,” meaning that the patient does not realize it is happening, or it can cause acute chest pain. When the artery relaxes and the spasm ends, the supply of blood to the heart returns and the pain resolves, if the patient experiences pain.
The cause of coronary artery spasm is not fully understood. It appears to be linked with risk factors such as smoking, high stress, high blood pressure, and high cholesterol. Patients with a history of angina can also experience coronary artery spasm. In other patients, there are no obvious risk factors, and indeed the patient may be quite healthy when examined by a physician. The spasms can recur at varying intervals for life.
Vasospasm, as constrictions of the blood vessels are known, can be tricky to treat and diagnose because once the spasm ends, the blood vessel returns to normal. In coronary artery spasm, a healthy or diseased blood vessel can be involved, but unless a doctor happens to be present with imaging equipment when the spasm happens, it may not immediately be identified. This is why it is important to report chest pain to a doctor and to describe the duration and the details as completely as possible, as this will provide diagnostic clues which can be valuable for treatment.
Once a doctor determines that coronary artery spasm is occurring, steps can be taken to treat it. Some medications can be used to manage coronary artery spasm, including beta blockers and calcium channel blockers. If the patient does present with risk factors, managing these factors can also help. For example, lowering cholesterol may decrease the risk of coronary artery spasm for the patient.
In cases where the coronary arteries are diseased, surgery to perform a bypass may be performed to address problems caused by the diseased vessels. This surgery is performed by a surgeon who specializes in procedures on the heart, and the prognosis for the patient post surgery varies, depending on a lot of factors including general health, the extent of the disease, and so forth.
Patients should be aware that cocaine use can complicate coronary artery spasm, and that cocaine can interact badly with some of the medications used to manage this condition. Cocaine users should disclose their drug use to their doctors; a doctor will not report the patient's drug use to anyone, but the information is very relevant to treatment and a patient could die from complications associated with cocaine use if a doctor is not made aware of it.