Causes, symptoms and diagnosis of spasm of the coronary vessels

Causes

The exact percentage of the prevalence of spasm of the coronary vessels, otherwise referred to as Prinzmetal's angina pectoris, among the population has not yet been established. This indicates that there are not many patients with such a diagnosis. However, due to the similarity of the clinical picture with other forms of coronary artery disease, you should always be aware of the possibility of this problem occurring.

At the heart of the occurrence of heart spasm are two key factors:

The presence of atherosclerotic plaques inside the vessel. It looks like an accumulation of fat and inflammatory cells that are deposited in the inner wall of the coronary (coronary) arteries.
Spasm. When you are under stress, smoke a lot or do heavy physical labor, there is a narrowing of the lumen of the vessels that feed your main "engine" in the body with blood. Given the presence of plaques in the arteries, the supply of oxygen to the muscle fibers of the heart sharply decreases, which provokes the onset of an attack.

These two factors remain key in the development of the disease.

Remember that the spasm rarely lasts longer than 5-10 minutes. This time is not enough for the occurrence of necrosis (heart attack, death) of individual muscle fibers, so you should not panic. However, a lack of cell nutrition develops with the addition of characteristic symptoms.

Now I will list the factors that provoke vasospasm of the heart:

Age. Traditionally, patients after 45-50 years of age suffer from variant angina.
Floor. Men are more susceptible to various types of coronary artery disease.
Atherosclerotic lesion of the vessels of the heart and the whole body. The more plaque (and the thicker they are) in your arteries, the higher the chance of typical signs of the disease.
Smoking. Nicotine is a substance that stimulates the spasm of arteries throughout the patient's body. Against the background of the presence of plaques in the vessels, an attack can occur after virtually every smoked cigarette. It all depends on the severity of the atherosclerotic process.
Stress. Under the influence of emotional stress, the muscular membrane of the vessels contracts, reducing the delivery of oxygen and nutrients to the cells of the heart.

Symptoms

Some of the patients I have worked with thought the symptoms were the same for everyone. That is why I had to explain to them that manifestations can vary depending on the individual characteristics of the organism. Of course, in this case, a number of general points can still be distinguished.

The clinical picture of variant angina pectoris, the cause of which is precisely a sharp decrease in the diameter of the coronary vessels, in many respects resembles traditional exertional angina. Most forms of ischemic heart disease are similar to each other. My task, as a doctor, remains the differential diagnosis of pathological conditions. The approach to treatment directly depends on this.

Complaints with which they turn to me or another cardiologist for help:

Pressing pain in the region of the heart, which can spread to the left arm, neck, jaw. I often hear it being compared to a twisting sensation, a cramp in the chest. Sometimes patients indicate a burning sensation, which can go away on its own within 5-10 minutes.
The acceleration of the heartbeat. Against the background of the pain syndrome, the pulse increases. Recently, a woman said that, in addition to discomfort in her chest, her "heart wanted to jump out through her mouth." Agree, this is a very eloquent description.
Dyspnea. A symptom that sometimes can be the only clinical manifestation of pathology.
Cold sweat. The symptom occurs in severe forms of the disease.
Nausea, vomiting, confusion are rare, but common satellites of variant angina pectoris.

It will be helpful for you to know that variant angina is not exercise-related. Most forms of ischemic heart disease are characterized by an increase in pain syndrome with active walking, lifting weights, and the like. With Prinzmetal's angina, sensations arise spontaneously, often at the same time of day. 55-65% of seizures occur in the early morning hours.

Diagnostic methods

To diagnose variant angina pectoris, according to modern recommendations and protocols, I use an integrated approach to assessing the patient's condition. Much in the process of identifying the underlying disease depends on the quality of the first conversation with the patient.

The key features that allow me to diagnose spasm of the coronary arteries are:

Episodic symptoms that are not related to exercise. Patients may suffer from chest pain in the morning, but in the afternoon go to the gym and do a full range of exercises.
The appearance of discomfort at about the same time of the day.
The short duration of the attack, which passes on its own with the further normalization of the person's condition.

To confirm the appropriate diagnosis, I always additionally prescribe a number of instrumental and laboratory studies.

Instrumental

Traditionally, the first thing to do is to register an ECG. This method makes it possible to assess the electrical function of the heart, which changes against the background of various forms of ischemic heart disease. It is important to note that there may not be any abnormalities on the ECG outside the seizure at all. This speaks in favor of the spasm of the coronary arteries. However, for the reliability of the study, it is necessary to "catch" the patient during the period of pain, which is sometimes extremely difficult, given the nocturnal attacks. The film will record ST segment elevation, which is typical for decreased blood supply to the myocardium.

For the convenience of the patient and to simplify my tasks, I use Holter monitoring. The technique provides for round-the-clock registration of an ECG in a particular patient with further interpretation of the results. With the help of this study, I can easily establish the timing of the episode of spasm of the coronary arteries.

Additional methods

For a full assessment of the patient's condition, the following procedures are also used:

Angiography of the vessels of the heart. The essence of the method is to visualize the patient's coronary arteries on the monitor after the injection of a contrast agent into the bloodstream. This allows me to pinpoint the exact location of the spasm. However, again, you need to "catch" the patient at the time of the attack.
Echocardiography. The technique is based on ultrasound examination of the heart. On the screen you can see the cavities of the organ, and I assess its functional activity. With Prinzmetal's angina pectoris, there are no special pathological changes.
Dosed load test. You are encouraged to exercise on a stationary bike or treadmill in a controlled environment. At this time, an ECG is recorded, the pressure is measured and the general condition is assessed. If there is pain in the heart, the procedure stops. However, patients with variant angina are traditionally well tolerated.

Based on the results of diagnostic procedures, an individual treatment is selected.

How dangerous is it?

The prognosis for patients with coronary vasospasm is relatively good. Pathology does not cause critical damage to the myocardium, but in the absence of adequate treatment, the risk of developing disturbances in the rhythmic activity of the heart remains. Such a problem can cause a significant deterioration in the patient's condition or even death.

Therefore, it is important to see a doctor in time. Compliance with his recommendations in 90% of cases contributes to the complete elimination of the clinical picture and stabilization of a person's well-being with a return to normal life.

Expert advice

The simplest and most effective advice that I give to all patients is to quit smoking. Nicotine causes a sharp vascular spasm, provoking an aggravation of the disease. In some cases, eliminating tobacco may be sufficient to minimize symptoms. It is important to understand that the more negative factors simultaneously affect you, the higher the chance of developing a heart spasm. You cannot change your gender and age. However, an elementary desire to quit smoking and the beginning of adequate therapy contributes to the complete elimination of the unpleasant symptoms of this disease.

Clinical case

A 46-year-old man came to our clinic with complaints of pressing pain in the chest, which arose at rest mainly at night and spread to the left arm. The patient suffers from the problem for 3 months. During the day, the symptoms disappear. Exercising in the gym does not aggravate the patient's condition. The disease is associated with the transferred stress.

The man smokes 1.5 packs of cigarettes a day, suffers from hypertension (160/100 mm Hg). ECG at rest without deviations. We decided to use Holter monitoring. At three o'clock in the morning, an ischemic attack lasting 4 minutes was recorded.

In the morning, upon repeated ECG registration, no pathological changes were found. The rest of the laboratory and instrumental tests are normal. The patient was diagnosed with coronary artery disease. Vasospastic angina pectoris, atherosclerosis of the coronary arteries. Arterial hypertension stage II, grade 2, risk. I have prescribed Amlodipine (10 mg once a day by mouth), Nitroglycerin (1 tablet under the tongue during an attack), Aspirin (75 mg once a day), Rosuvastatin (20 mg per day), lifestyle correction - quitting smoking, minimizing stress. On re-examination after 2 weeks, the patient noted the complete absence of new attacks of chest pain. Feels good, exercise tolerance without restrictions.

I would be glad if this article was helpful. Share your experience about the experienced episodes of squeezing pain in the heart in the comments: how did you save yourself and what helps better. Our experts will help you understand the situation.