Coronary artery vasospasm - Revision history

Danbot: Strip excess bold text

2026-03-22T09:24:00Z

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	==Evaluation==		==Evaluation==
	*~~'''~~[[ECG]]~~'''~~		*[[ECG]]
	**Characteristically demonstrates transient ST elevation during spasm		**Characteristically demonstrates transient ST elevation during spasm
	**May be followed by ST depression or T-wave inversion<ref>Miwa K. Two electrocardiographic patterns with or without transient T-wave inversion during recovery periods of variant anginal attacks</ref>		**May be followed by ST depression or T-wave inversion<ref>Miwa K. Two electrocardiographic patterns with or without transient T-wave inversion during recovery periods of variant anginal attacks</ref>
	*~~'''~~Labs~~'''~~		*Labs
	**[[Troponin]](often negative)		**[[Troponin]](often negative)
	**Toxicology screen (if cocaine suspected as etiology)		**Toxicology screen (if cocaine suspected as etiology)
	*~~'''~~Imaging~~'''~~		*Imaging
	**[[CXR]] (R/O other etiologies)		**[[CXR]] (R/O other etiologies)
	*~~'''~~Other~~'''~~		*Other
	**Holter monitor (helpful in identifying dysrhythmia or silent cases)		**Holter monitor (helpful in identifying dysrhythmia or silent cases)
	**Stress testing		**Stress testing
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	==Disposition==		==Disposition==
	*~~'''~~Admission~~'''~~		*Admission
	**Consider admission for serial cardiac enzymes and provocative testing		**Consider admission for serial cardiac enzymes and provocative testing
	***Sometimes spasm occurs around an already existing plaque		***Sometimes spasm occurs around an already existing plaque
	*~~'''~~Discharge~~'''~~		*Discharge
	**Discharge hemodynamically stable patients who have a negative ischemic workup		**Discharge hemodynamically stable patients who have a negative ischemic workup
	**Provide smoking cessation education		**Provide smoking cessation education

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External Links

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	==External Links==		==External Links==
			*[https://www.merckmanuals.com/professional/cardiovascular-disorders/coronary-artery-disease/variant-angina?query=prinzmetal%20angina\| Merk Manual: Variant Angina (Prinzmetal Angina)]

	==References==		==References==

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Disposition

← Older revision		Revision as of 19:24, 15 July 2021
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	==Disposition==		==Disposition==
	*Consider admission for serial cardiac enzymes and provocative testing		*'''Admission'''
	*Sometimes spasm occurs around an already existing plaque		**Consider admission for serial cardiac enzymes and provocative testing
			***Sometimes spasm occurs around an already existing plaque
			*'''Discharge'''
			**Discharge hemodynamically stable patients who have a negative ischemic workup
			**Provide smoking cessation education
			**Follow up w/ cardiology within one week

	==See Also==		==See Also==

Blsimpso: /* Evaluation */

2021-07-15T19:14:57Z

Evaluation

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	==Evaluation==		==Evaluation==
	*[[ECG]] ~~and troponin~~		*'''[[ECG]]'''
	**~~May demonstrate~~ ST elevation during spasm~~, but~~ [[~~troponin~~]] often negative		**Characteristically demonstrates transient ST elevation during spasm
	*[[CXR]]		**May be followed by ST depression or T-wave inversion<ref>Miwa K. Two electrocardiographic patterns with or without transient T-wave inversion during recovery periods of variant anginal attacks</ref>
	*Holter monitor		*'''Labs'''
	*Stress testing ~~typically~~ done to evaluate for fixed CAD		**[[Troponin]](often negative)
	**Often yields negative results <ref>Stern SS. Coronary artery spasm: a 2009 update.. Circulation (New York, N.Y.). 2009-05;119:2531-2534.</ref>		**Toxicology screen (if cocaine suspected as etiology)
	*Coronary angiography considered in following patients:<ref> Montalescot G, Sechtem U, Achenbach S, et al. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J. 2013;34(38):2949-3003.</ref>		*'''Imaging'''
	**[[ECG]] with STE		**[[CXR]] (R/O other etiologies)
	**History strongly indicative and stress testing/ambulatory monitoring are normal		*'''Other'''
			**Holter monitor (helpful in identifying dysrhythmia or silent cases)
			**Stress testing
			***Typically done to evaluate for fixed CAD; often yields negative results<ref>Stern SS. Coronary artery spasm: a 2009 update.. Circulation (New York, N.Y.). 2009-05;119:2531-2534.</ref>
			**Coronary angiography considered in following patients:<ref> Montalescot G, Sechtem U, Achenbach S, et al. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J. 2013;34(38):2949-3003.</ref>
			***[[ECG]] with STE
			***History strongly indicative and stress testing/ambulatory monitoring are normal

	==Management==		==Management==

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Background

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	==Background==		==Background==
			*Commonly referred to as ''Prinzmetal Angina'' or ''Variant Angina''
	*Typically affects patients <50 yo		*Typically affects patients <50 yo
	*Associated with transient [[ST elevation]] in local distribution		*Associated with transient [[ST elevation]] in local distribution
	*Often occurs in early morning <ref> Prinzmetal M, Kennamer R, Merliss R, Wada T, Bor N. Angina pectoris. I. A variant form of angina pectoris; preliminary report. Am J Med. 1959;27:375-88.</ref>		*Often occurs in early morning <ref> Prinzmetal M, Kennamer R, Merliss R, Wada T, Bor N. Angina pectoris. I. A variant form of angina pectoris; preliminary report. Am J Med. 1959;27:375-88.</ref>
	*Mechanism is likely vagal withdrawal		*Mechanism is likely vagal withdrawal
	*Tobacco use a major risk factor<ref> Takaoka K. Comparison of the risk factors for coronary artery spasm with those for organic stenosis in a Japanese population: role of cigarette smoking. Int J Cardiol. 2000;72:121–126.</ref>		*Tobacco use a major risk factor (up to 75% of cases)<ref> Takaoka K. Comparison of the risk factors for coronary artery spasm with those for organic stenosis in a Japanese population: role of cigarette smoking. Int J Cardiol. 2000;72:121–126.</ref>
	*May be associated with migraines <ref> Rosamond W. Are migraine and coronary heart disease associated? An epidemiologic review. Headache. 2004;44 Suppl 1:S5-12. </ref>		*May be associated with migraines <ref> Rosamond W. Are migraine and coronary heart disease associated? An epidemiologic review. Headache. 2004;44 Suppl 1:S5-12. </ref>
	*Vfib, tachycardia, and complete AV block may be associated with ischemic episodes		*Vfib, tachycardia, and complete AV block may be associated with ischemic episodes

ClaireLewis at 21:42, 22 August 2019

2019-08-22T21:42:33Z

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	==Background==		==Background==
	*Typically affects patients <50 yo		*Typically affects patients <50 yo
	*Associated with transient ST ~~deviation~~ in local distribution		*Associated with transient [[ST elevation]] in local distribution
	*Often occurs in early morning <ref> Prinzmetal M, Kennamer R, Merliss R, Wada T, Bor N. Angina pectoris. I. A variant form of angina pectoris; preliminary report. Am J Med. 1959;27:375-88.</ref>		*Often occurs in early morning <ref> Prinzmetal M, Kennamer R, Merliss R, Wada T, Bor N. Angina pectoris. I. A variant form of angina pectoris; preliminary report. Am J Med. 1959;27:375-88.</ref>
	*Mechanism is likely vagal withdrawal		*Mechanism is likely vagal withdrawal
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	==Clinical Features==		==Clinical Features==
	*Chest discomfort/tightness/pressure		*[[Chest pain\|Chest discomfort]]/tightness/pressure
	*Gradual onset/resolution		**Gradual onset/resolution
	*No respirophasic component to pain		**No respirophasic component to pain
	*Poorly localized; radiation of pain is common		**Poorly localized; radiation of pain is common
	*Associated with nausea, ~~diaphroesis~~, and ~~palpations~~		**Often no exertional component to chest pain
			***Exertion results in variable symptoms, including increase, decreased, or no change in chest pain
			****Makes exertional symptoms unreliable
			*Associated with [[nausea]], diaphoresis, and [[palpitations]]
	*Attacks may be precipitated by hyperventilation		*Attacks may be precipitated by hyperventilation
	*Often no exertional component to chest pain
	**Exertion results in variable symptoms, including increase, decreased, or no change in chest pain
	**Makes exertional symptoms unreliable

	==Differential Diagnosis==		==Differential Diagnosis==

Kxl328: /* Clinical Features */

2018-10-12T03:25:13Z

Clinical Features

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	*Chest discomfort/tightness/pressure		*Chest discomfort/tightness/pressure
	*Gradual onset/resolution		*Gradual onset/resolution
	*Often no exertional component to chest pain
	*No respirophasic component to pain		*No respirophasic component to pain
	*Poorly localized; radiation of pain is common		*Poorly localized; radiation of pain is common
	*Associated with nausea, diaphroesis, and palpations		*Associated with nausea, diaphroesis, and palpations
	*Attacks may be precipitated by hyperventilation		*Attacks may be precipitated by hyperventilation
			*Often no exertional component to chest pain
			**Exertion results in variable symptoms, including increase, decreased, or no change in chest pain
			**Makes exertional symptoms unreliable

	==Differential Diagnosis==		==Differential Diagnosis==

Neil.m.young: Text replacement - "beta blocker" to "β-blocker"

2017-07-30T19:55:10Z

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	**[[Diltiazem]] 240-360mg/day		**[[Diltiazem]] 240-360mg/day
	**Isosorbide mononitrate considered 2nd line due to adverse effect profile		**Isosorbide mononitrate considered 2nd line due to adverse effect profile
	*Avoid nonselective [[~~beta~~ blockers]] as they may exacerbate vasospasm <ref>Robertson RM, Wood AJ, Vaughn WK, Robertson D. Exacerbation of vasotonic angina pectoris by propranolol. Circulation. 1982;65(2):281-5. </ref>		*Avoid nonselective [[β-blockers]] as they may exacerbate vasospasm <ref>Robertson RM, Wood AJ, Vaughn WK, Robertson D. Exacerbation of vasotonic angina pectoris by propranolol. Circulation. 1982;65(2):281-5. </ref>
	*[[ASA]] used with caution and at low dose in patients without history of CAD <ref>Miwa K, Kambara H, Kawai C. Effect of aspirin in large doses on attacks of variant angina. Am Heart J. 1983;105(2):351-5.</ref>		*[[ASA]] used with caution and at low dose in patients without history of CAD <ref>Miwa K, Kambara H, Kawai C. Effect of aspirin in large doses on attacks of variant angina. Am Heart J. 1983;105(2):351-5.</ref>

Rossdonaldson1: Text replacement - "troponin " to "troponin "

2016-12-04T14:24:57Z

Text replacement - "troponin " to "troponin "

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	==Evaluation==		==Evaluation==
	*[[ECG]] and troponin		*[[ECG]] and troponin
	**May demonstrate ST elevation during spasm, but troponin often negative		**May demonstrate ST elevation during spasm, but [[troponin]] often negative
	*[[CXR]]		*[[CXR]]
	*Holter monitor		*Holter monitor

Rossdonaldson1: Text replacement - "CXR" to "CXR"

2016-09-09T14:05:27Z

Text replacement - "*CXR" to "*CXR"

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	*[[ECG]] and troponin		*[[ECG]] and troponin
	**May demonstrate ST elevation during spasm, but troponin often negative		**May demonstrate ST elevation during spasm, but troponin often negative
	*CXR		*[[CXR]]
	*Holter monitor		*Holter monitor
	*Stress testing typically done to evaluate for fixed CAD		*Stress testing typically done to evaluate for fixed CAD