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Coronary Artery Spasm

Last updated Aug. 15, 2018

Approved by: Krish Tangella MD, MBA, FCAP

Coronary Artery Spasms (CAS) are temporary spasms that occur in the arteries, which supply blood to the heart (known as coronary arteries). The spasms cause the arteries to narrow, resulting in a reduced flow of blood to the heart.

What are the other Names for this Condition? (Also known as/Synonyms)

  • Angina with Coronary Spasm
  • CAS (Coronary Artery Spasm)
  • Coronary Arteriospasm

What is Coronary Artery Spasm? (Definition/Background Information)

  • Coronary Artery Spasms (CAS) are temporary spasms that occur in the arteries, which supply blood to the heart (known as coronary arteries). The spasms cause the arteries to narrow, resulting in a reduced flow of blood to the heart
  • The main symptom of CAS is variant angina, which occurs when the heart does not get enough blood and oxygen, due to reduced blood flow. Variant angina is different from normal angina. The main difference is that variant angina occurs at rest, while typical angina occurs during activities involving any physical exertion
  • The cause of Coronary Artery Spasm is currently unknown; though, there are several known triggers. The major triggers are smoking and the use of illegal drugs. Individuals, who smoke or have coronary artery disease, are at a much higher risk. The best way to prevent CAS is thus, to avoid the triggers and maintain a healthy heart
  • The major complications of CAS include myocardial infarction and arrhythmia. Even though both conditions do not occur frequently, they are very serious when they occur, as there is a significant risk of fatalities
  • The standard preventive treatments for Coronary Artery Spasms are calcium-channel blockers and long-acting nitroglycerin. In the event that CAS occurs, the medication used is short-acting nitroglycerin
  • Many individuals are able to control CAS through calcium-channel blockers and long-acting nitroglycerin. However, the prognosis for Coronary Artery Spasm is based on whether the individual has coronary heart disease, and if so, to what extent has it progressed

Who gets Coronary Artery Spasm? (Age and Sex Distribution)

  • Coronary Artery Spasms affect middle-aged adults, generally less than 50 years of age
  • Men are more likely to be affected by CAS than women
  • All races and ethnic groups are vulnerable, although Coronary Artery Spasms and variant angina are known to disproportionately affect individuals of Japanese and Korean descent

What are the Risk Factors for Coronary Artery Spasm? (Predisposing Factors)

The risk factors for Coronary Artery Spasm include:

  • Smoking and coronary heart disease (CHD) are the two key risk factors
  • An advanced age, genetics, insulin-resistance, and substance abuse, are also risk factors, though they are not as significant as smoking and CHD

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Coronary Artery Spasm? (Etiology)

The exact cause of Coronary Artery Spasm has not been confirmed. It is a temporary condition, but the following triggers of CAS have been identified:

  • Smoking
  • Use of illicit drugs including marijuana, cocaine, amphetamines, and others
  • Alcohol consumption
  • Medications that cause narrowing of the arteries
  • Mental stress
  • Exposure to cold
  • Low magnesium levels
  • Migraines

What are the Signs and Symptoms of Coronary Artery Spasm?

The signs and symptoms of Coronary Artery Spasm include:

  • The most common symptom is angina, which is a pain or tightness in the chest. However, pain may also be felt in the shoulders, back, neck, jaw, or arm. The pain can last anywhere from 5-30 minutes. Any spasms over 15 minutes may be termed as severe, causing harm to the heart muscles. The pain occurs due to a lack of blood flow to the heart, which is caused by narrowing of the coronary artery during spasm
  • However, the angina caused by CAS is different from typical angina. The ‘CAS-caused angina’ is called variant angina or Prinzmetal’s angina. Anginas normally occur when the individual exerts themselves physically, while variant anginas occur during rest. Another characteristic features to differentiate variant angina is that the pain usually occurs in the hours from 12 A.M. to 8 A.M.
  • Some individuals do not experience any pain, but may have other symptoms such as shortness of breath
  • Cardiac arrhythmia
  • In extreme cases, individuals may become unconscious

How is Coronary Artery Spasm Diagnosed?

The common tools to diagnose a Coronary Artery Spasm may include:

  • Physical examination with medical history evaluation
  • An electrocardiogram (ECG) during the spasms is the best way to confirm Coronary Artery Spasm. However, this is generally not possible, because by the time individuals receive ambulatory care, the spasms may subside. However, an ambulatory ECG may be performed to detect the spasms that are still taking place, or if there are arrhythmias due to CAS
  • The cardiologist may also perform a stress test ECG. This test is usually negative, but sometimes the exercise may induce a CAS
  • Also, blood tests may be performed to find levels of cardiac enzymes and troponin, as these can indicate any acute cardiac condition
  • A cardiac angiogram will almost always be performed to confirm a diagnosis. An angiogram allows the physician to visualize the narrowing or blockage of the coronary arteries
  • If the individual is unable to undergo an angiogram, a myocardial perfusion scan or magnetic resonance imaging may be conducted, for diagnostic purposes
  • The physician will also look for symptoms that indicate variant angina. These include angina while resting, angina in early morning hours, and improvement with nitroglycerin

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Coronary Artery Spasm?

The two major complications of Coronary Artery Spasms are myocardial infarction (heart attack) and arrhythmias (irregular heartbeat).

  • Heart attacks may occur, if CAS lasts for 15 or more minutes. Also, individuals with coronary heart disease are more likely to have a heart attack from CAS. The severity of the heart attack is also dependent on the extent of coronary heart disease
  • Arrhythmias do not occur often, but when they do, they are extremely serious. This is due to the fact that when a CAS-induced arrhythmia occurs, it is often ventricular tachycardia, ventricular fibrillation, or atrio-ventricular block. A ventricular fibrillation can lead to death within minutes

Death can also occur, if the spasms occur in multiple arteries. This is the most common cause of cardiac arrest caused by a Coronary Artery Spasm.

How is Coronary Artery Spasm Treated?

The treatment of Coronary Artery Spasms may be undertaken as follows:

  • The standard medication for CAS is nitroglycerin and calcium channel blockers
    • These drugs relax and dilate the blood vessels that supply blood to the heart
    • Short-acting nitroglycerin is given to relieve acute symptoms such as angina and shortness of breath
    • The calcium-channel blockers are used to prevent a CAS episode from recurring; it is a long-term treatment
    • Long-acting nitroglycerin may also be given in combination with the calcium-channel blockers to increase effectiveness
    • Statins may also be prescribed to prevent plaque accumulation in arteries. In some cases, CAS can damage walls of an artery that causes plaque to accumulate at the site. Statins also have some other effects that help prevent recurrent CAS

Surgical treatments are available, but these are not used frequently. The two invasive procedures are stents and implantable cardiac defibrillators (ICD).

  • These procedure are only considered, if the calcium-channel blockers and long-acting nitrates are ineffective in preventing further spasms
  • A stent will prevent the artery from narrowing in the event of a CAS
  • In some individuals, Coronary Artery Spasms will cause life-threatening arrhythmias. The physicians may recommend an ICD, if CAS and therefore arrhythmias, cannot be prevented with medication

How can Coronary Artery Spasm be Prevented?

The best way to prevent a Coronary Artery Spasm is to avoid the triggers that cause the spasms.

  • The two most significant triggers to avoid are smoking and the use of illegal drugs/substances
  • Other steps that may be taken are to ensure a good health of the heart, which include:
    • Eating healthy
    • Regular exercising
    • Controlling blood pressure and cholesterol levels
    • Keeping a healthy body weight
    • Avoiding unnecessary stresses 

What is the Prognosis of Coronary Artery Spasm?

  • Overall, the prognosis of Coronary Artery Spasms is excellent, if the individual is regular in taking the prescribed medications and avoids the possible triggers
  • Nevertheless, the prognosis is highly-dependent on whether the individual has any underlying coronary heart disease (CHD), and if so, its severity. Individuals with CHD typically have poorer prognoses

Additional and Relevant Useful Information for Coronary Artery Spasm:

Coronary Artery Spasms affect about 4 in 100,000 individuals; most of the affected individuals have coronary heart disease to some degree or the other.

What are some Useful Resources for Additional Information?

References and Information Sources used for the Article:

Helpful Peer-Reviewed Medical Articles:

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: March 24, 2016
Last updated: Aug. 15, 2018