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Vasospastic Angina and its Relationship with the Coronary Microcirculation
Edina Cenko1, Maria Bergami1, Elisa Varotti1
1Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy.
Current Pharmaceutical Design
|June 26, 2018
Summary
Vasospastic angina, a cause of chest pain from coronary artery vasospasm, presents diverse clinical patterns. Understanding its varied mechanisms is crucial for patient outcomes.
Area of Science:
- Cardiology
- Vascular Medicine
Background:
- Vasospastic angina (VSA) causes chest pain due to coronary artery vasospasm, impacting quality of life and potentially leading to severe outcomes like myocardial infarction and death.
- Initially described as Prinzmetal or variant angina, VSA was thought to be a focal spasm in non-obstructed arteries.
- Clinical observations revealed a broader, more polymorphic presentation of coronary artery vasospasm than initially recognized.
Purpose of the Study:
- To explore the evolving understanding of vasospastic angina.
- To highlight the variability in clinical presentation of coronary artery vasospasm.
- To review proposed underlying mechanisms of VSA.
Main Methods:
- Review of historical and current clinical understanding of vasospastic angina.
- Analysis of the spectrum of coronary artery vasospasm presentations.
- Synthesis of proposed pathophysiological mechanisms.
Main Results:
- Coronary artery vasospasm is now understood to be more polymorphic, ranging from focal to diffuse epicardial involvement.
- VSA is associated with significant morbidity and mortality.
- Proposed mechanisms include parasympathetic dysfunction, endothelial dysfunction with blunted nitric oxide response, increased vasoconstrictors, and oxidative stress.
Conclusions:
- Vasospastic angina presents with significant variability in clinical practice.
- The pathophysiology of VSA is multifactorial, involving endothelial dysfunction and neuro-autonomic imbalances.
- Further research into the complex mechanisms of VSA is warranted to improve patient management.
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