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Medical News Today: Coronary artery spasm: What to know

A coronary artery spasm happens when the walls of blood vessels squeeze together, causing a part of the blood vessel to narrow.

The spasm itself is not always severe or even painful. Sometimes, however, it can lead to serious problems, including heart attack or even death.

Accurately detecting and diagnosing the condition can pose a challenge for healthcare teams. Many different things can cause heart disease and chest pain, so it can be difficult for doctors to single out coronary artery spasms.

Treatment is usually not complicated, and there are many options available that can help treat the symptoms and the underlying cause.

What is a coronary artery spasm?

coronary artery narrowing caused by a spasm.
A segment of the coronary artery may narrow during a spasm.

A coronary artery spasm occurs when a segment of an artery, which carries blood to the heart, tightens and narrows.

As the artery spasms, the heart is forced to work harder to pump blood through the affected area.

The average spasm lasts only a few minutes, but some can last 30 minutes or more. Unlike chest pain caused by other forms of heart disease, a coronary artery spasm most often occurs when a person is resting rather than exercising.

Coronary artery spasms are tricky to diagnose. No one knows precisely how many people experience coronary artery spasm because it does not always cause symptoms.

Experts suspect that younger people are affected by coronary artery spasm more often than by other types of heart disease. It also tends to impact more females than males.

Causes

Doctors do not fully understand why some people have coronary artery spasms.

One of the most common risk factors is smoking. Other potential causes or triggers of a coronary artery spasm include:

  • using vasoconstrictor drugs, including beta blockers
  • exposure to cold
  • extreme stress
  • use of stimulant drugs, such as cocaine
  • excessive alcohol use or alcohol withdrawal
  • excessive cannabis use
  • chemotherapy
  • magnesium deficiency

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What does a coronary artery spasm feel like?

Man clutching his chest because of heart pains
Severe chest pain can occur during coronary artery spasms.

Symptoms can vary from person to person or even between different occurrences.

Some spasms are “silent,” meaning they can occur without causing any symptoms.

When symptoms do occur, they can include:

  • chest pain, which may be severe
  • pain that may radiate to head or shoulders
  • burning feeling in the chest
  • a sense of tightness in the chest
  • pressure or squeezing sensation

Complications

If left untreated, coronary artery spasms can lead to heart attack or death, even when a person does not have any symptoms. However, life-threatening complications are uncommon.

Coronary artery spasm can also cause different forms of arrhythmia, which is a change in the way the heart beats.

Arrhythmia is very common and can make a person feel as if their heart has “skipped a beat.”

Diagnosis

There are three main ways to diagnose coronary artery spasm:

  • Coronary angiography: This is an X-ray-like test that creates images of blood vessels instead of bones.
  • Electrocardiogram: A test that checks for abnormal electrical patterns in the heart. This test is particularly useful for coronary artery spasm, as the condition causes irregular heart rhythms.
  • Echocardiogram: This technique uses ultrasound technology to get a glimpse into heart valves and blood flow.

These tests are often enough for a diagnosis, but the only way to definitively diagnose coronary artery spasm is by doing an additional test called provocative testing.

During provocative testing, doctors use specific drugs to cause or “provoke” a spasm, which allows them to diagnose the condition with certainty.

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Treatment

Broken cigarette.
Quitting smoking can reduce the risk of coronary artery spasms.

There is no cure for coronary artery spasm, but there are several ways to treat the condition and reduce symptoms.

Quitting smoking is the most helpful lifestyle change for coronary artery spasm. Eating a nutritious diet with plenty of fruits and vegetables and exercising regularly can also help reduce symptoms.

A doctor may also prescribe certain medications, including:

  • calcium channel blockers to reduce muscle tightening in the chest
  • nitrates to ease chest pain
  • statins to lower cholesterol and strengthen arteries

When medications and lifestyle changes do not work, more invasive procedures can force a troublesome artery to open and stay open over time. Bypass surgery is a last resort.

Outlook

The chances of long-term survival are good, as are the chances of controlling the spasms and their symptoms over time.

Avoiding smoking is critical. A person should continue taking any medications or other treatments even if they feel better because the spasms that do not cause any symptoms are just as dangerous as the ones that do.

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