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Coronary vasospasm: A narrative review
Jacob Jewulski1, Sumesh Khanal2, Khagendra Dahal3
1Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI 48309, United States.
Insights
Coronary artery vasospasm (CAVS) causes acute chest pain. Research is ongoing to understand its causes, diagnosis, and treatments beyond current calcium channel blockers and nitrates.
Area of Science:
- Cardiology
- Vascular Biology
Background:
- Coronary artery vasospasm (CAVS) is a key factor in acute chest pain syndrome.
- Autonomic and endothelial dysfunction are implicated in CAVS pathophysiology.
- Prevalence varies, with higher rates in East Asian and female populations.
Purpose of the Study:
- To review the current understanding of coronary artery vasospasm.
- To highlight diagnostic challenges and emerging non-invasive methods.
- To discuss current and future treatment strategies for CAVS.
Main Methods:
- Review of existing literature on coronary artery vasospasm.
- Analysis of diagnostic modalities, including provocative testing and biomarkers.
- Evaluation of therapeutic interventions and risk factor modification.
Main Results:
- CAVS pathophysiology involves autonomic and endothelial dysfunction.
- Smoking is a risk factor, but CAVS differs from traditional coronary artery disease.
- Chemotherapeutics, allergens, and inflammatory mediators are identified triggers.
- Provocative testing is the gold standard for diagnosis; non-invasive tests are under investigation.
- Calcium channel blockers are first-line treatment, with nitrates as adjuncts.
- Implantable cardioverter defibrillators (ICDs) are considered for high-risk patients.
Conclusions:
- Further research is needed to fully elucidate CAVS pathophysiology and optimize treatment.
- Non-invasive diagnostic tools and targeted therapies, including those for oxidative stress, require further investigation.
- Risk factor modification and appropriate medical therapy are crucial for managing CAVS.
Abstract:
Coronary artery vasospasm (CAVS) plays an important role in acute chest pain syndrome caused by transient and partial or complete occlusion of the coronary arteries. Pathophysiology of the disease remains incompletely understood, with autonomic and endothelial dysfunction thought to play an important role. Due to the dynamic nature of the disease, its exact prevalence is not entirely clear but is found to be more prevalent in East Asian and female population. Cigarette smoking remains a prominent risk factor, although CAVS does not follow traditional coronary artery disease risk factors. Many triggers continue to be identified, with recent findings identifying chemotherapeutics, allergens, and inflammatory mediators as playing some role in the exacerbation of CAVS. Provocative testing with direct visualization is currently the gold-standard for diagnosis, but non-invasive tests, including the use of biomarkers, are being increasingly studied to aid in the diagnosis. Treatment of the CAVS is an area of active research. Apart from risk factor modification, calcium channel blockers are currently the first line treatment, with nitrates playing an important adjunct role. High-risk patients with life-threatening complications should be considered for implantable cardioverter defibrillator (ICD), although timing criteria for escalated therapy require further investigation. The role of pharmaceuticals targeting oxidative stress remains incompletely understood.
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