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The Who, What, Why, When, How and Where of Vasospastic Angina

John F Beltrame1, Filippo Crea, Juan Carlos Kaski

  • 1The Queen Elizabeth Hospital Discipline of Medicine, University of Adelaide, Central Adelaide Local Health Network.

Circulation Journal : Official Journal of the Japanese Circulation Society
|December 22, 2015
PubMed

Insights

Functional coronary artery disease (CAD), specifically vasospastic angina, is often overlooked. Early diagnosis and vasodilator therapy are crucial for preventing major adverse events in patients with this condition.

Area of Science:

  • Cardiology
  • Vascular Medicine
  • Internal Medicine

Background:

  • Ischemic heart disease encompasses structural and functional coronary circulation disorders.
  • Atherosclerotic coronary artery disease (CAD) is well-understood, unlike functional CAD.
  • Functional CAD, including vasospastic angina, warrants greater clinical attention.

Purpose of the Study:

  • To review contemporary aspects of vasospastic angina, a form of functional CAD.
  • To highlight the importance of diagnosing and managing coronary artery spasm.
  • To provide a state-of-the-art consensus on vasospastic angina.

Main Methods:

  • Review of contemporary literature on vasospastic angina.
  • Analysis of clinical presentation, diagnostic criteria, and treatment strategies.
  • Emphasis on provocative spasm testing for diagnosis.

Main Results:

  • Vasospastic angina presents as angina at rest, responsive to nitrates, with transient ECG changes.
  • Diagnosis may require provocative spasm testing.
  • Prompt diagnosis and vasodilator therapy (e.g., calcium-channel blockers) can prevent major adverse events.

Conclusions:

  • Vasospastic angina is a significant cause of functional CAD.
  • Diagnosis is essential for preventing adverse cardiovascular events.
  • Further research is needed on pathophysiology, natural history, and refractory cases.

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