Coronary Artery Spasm: Pathophysiology, Diagnosis, and Clinical Implications

Area of Science:

• Cardiology
• Vascular Biology
• Pathophysiology

Background:

• Coronary artery spasm (CAS) is a dynamic vasomotor disorder causing transient, intense constriction of epicardial coronary arteries.
• CAS is implicated in vasospastic angina, myocardial infarction with nonobstructive coronary artery disease (MINOCA), arrhythmias, and sudden cardiac death.
• Pathophysiology involves endothelial dysfunction, smooth muscle hyperreactivity, inflammation, oxidative stress, autonomic imbalance, and genetic factors, with ethnic and sex variations.

Purpose of the Study:

• To review the pathophysiology, diagnosis, and management of coronary artery spasm.
• To highlight the role of CAS in various cardiac conditions.
• To emphasize the need for improved recognition and standardized diagnostic approaches.

Main Methods:

• Review of existing literature on coronary artery spasm.
• Integration of clinical features, ECG changes, and invasive coronary provocation testing (acetylcholine or ergonovine).
• Consideration of advanced imaging and functional assessments for microvascular involvement.

Main Results:

• CAS leads to myocardial ischemia in patients with and without obstructive coronary artery disease.
• Diagnosis requires a combination of clinical presentation, ECG, and provocative testing.
• Management includes calcium channel blockers, nitrates, risk factor modification (especially smoking cessation), and tailored strategies for complex cases.

Conclusions:

• CAS is a significant contributor to various acute coronary syndromes and arrhythmias.
• Standardized diagnostic pathways and improved clinical recognition are essential for optimal patient outcomes.
• Effective management involves pharmacotherapy, lifestyle changes, and individualized treatment plans to mitigate life-threatening complications.