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Coronary Artery Spasm

Coronary artery spasm is a type of angina. It is also called vasospastic, variant, or Prinzmetal angina. Angina is pain that is caused by the heart muscles not getting enough blood. A sudden spasm or narrowing of a blood vessel that supplies the heart causes angina by reducing the amount of oxygen the heart receives. Coronary artery spasms often cause pain. Sometimes severe spasms can lead to irregular heartbeats. They can even cause heart attack, also known as acute myocardial infarction (AMI), and sudden death.

How coronary artery spasm differs from other anginas

Cross section of artery with narrowing due to spasm.
Coronary artery spasm occurs when the wall of an artery contracts suddenly, narrowing the artery.

This condition differs from other types of angina. To start, other types of angina commonly occur when the person is active and tend to occur in people with coronary artery disease (CAD). With CAD, arteries in the heart have a buildup of a fatty substance called plaque. In contrast, coronary artery spasm most often occurs when the person is resting. In fact, it often occurs at night during sleep, usually between midnight and early morning.

Symptoms of coronary artery spasm

The main symptom is a squeezing, crushing, or burning feeling in the chest. It is temporary, often lasting 5 to 30 minutes. Loss of consciousness may also occur. In some cases, there are no symptoms (a “silent” spasm).

Risk factors for coronary artery spasm

Risk factors are things that make you more likely to have a certain condition. Coronary artery spasm has several key risk factors. These include:

  • Smoking (the most significant risk factor)

  • Coronary atherosclerosis

  • Genetics

  • Insulin resistance

But coronary artery spasm often occurs in people without these risk factors.

Triggers for coronary artery spasm

Triggers are things that can prompt a spasm to occur. These can include:

  • Smoking

  • Use of stimulant drugs (such as cocaine and amphetamines)

  • Changes in heart rate regulation by the nervous system

  • Magnesium deficiency

  • Emotional stress

  • Alcohol use

  • Exposure to cold

  • Migraines

  • Use of medications that cause narrowing of the blood vessels

Diagnosis of coronary artery spasm

The doctor will take a health history and ask you to describe your symptoms. You’ll have a physical exam and certain tests may be done. These include:

  • Electrocardiogram (EKG). This test records the electrical activity of your heart. An EKG can detect an abnormal pattern, particularly during the chest pain episode. It can also detect an irregular heart rhythm associated with coronary artery spasm.

  • Coronary angiography. This is a special type of X-ray. It creates pictures of your coronary arteries. These pictures show any narrowing or blockage in these blood vessels. This is the gold standard for confirming the diagnosis of coronary artery spasm.

Treatment of coronary artery spasm

There are two main types of treatment for coronary artery spasm.

  • Medications, the primary treatment, include:

    • Calcium channel blockers. These can help prevent spasms. Medications called long-acting nitrates may be prescribed for use with calcium channel blockers.

    • Nitroglycerin. This can help ease the pain of a spasm once it’s begun.

If you are prescribed these or any other medications, follow your doctor’s instructions on how and when to take them.

  • Lifestyle changes can also help prevent spasms. Start by avoiding the triggers listed above. Also, talk to your doctor about what you can do to reduce your risk of CAD. This may include an improved diet and an exercise plan. If you smoke, your doctor will talk with you about ways to stop.


Signs of a heart attack

Because of your risk, you need to watch for signs of heart attack. Don’t be afraid to call 911, even if you’re not sure you are having a heart attack. Below are some common symptoms of heart attack:

  • Pressure, squeezing, or pain in your chest, neck, jaw, shoulders, arms, or back

  • Severe shortness of breath

  • Dizziness or faintness

  • Nausea and vomiting

  • Rapid or irregular heartbeat

  • Sweating

Other possible symptoms that occur more often in women include:

  • Abdominal pain

  • Heartburn

  • Clammy skin

  • Severe tiredness

  • Anxiety

Online Medical Reviewer: Foster, Sarah, RN, MPH
Online Medical Reviewer: Image reviewed by StayWell medical illustration team.
Online Medical Reviewer: MMI board-certified, academically affiliated clinician
Last Review Date: 3/7/2014
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