Coronary Artery Spasm

Posted By  CCF Cardio MD-SGM on December 16, 1997 at 20:21:56:

In Reply to: Coronary Artery Spasm posted by Carol on December 04, 1997 at 15:57:20:

: I am a 48 year old woman, 3 1/2 years ago I had a heart attack with no
  previous angina. I was kept in our local hospital on heparin etc. for 3
  weeks until I was transported to the Heart Institute. The next morning I
  had an angigram and immediate bypass surgery. The LAD was 99.9% blocked.
  Over the last 3 years I have been having angina at rest-never after exercise.
  I have just had another angigram and have been told there are no blockages
  but that an artery went into spasm will the angiogram was being done. I am
  now on cardizem 240mg. and nitro patch 0.8 for 14 hrs. per day. I have
  been trying to find information on Coronary Artery Spasm but all I can find
  is a line here or there. Can you suggest reading material or sources of
  more information.
  

[CCF Cardio MD-SGM]

_-
Dear Carol,
I'll discuss the issue of Variant Angina due to Coronary Artery Spasm, a syndrome also known as Prinzemetal's angina.   Unlike the vast majority of heart attacks and angina episodes that are due to atherosclerosis and plaque rupture within the coronary artery,  Variant Angina is characterized by an abrupt, transient spasm of the coronary arteries that results in decreased blood flow, oxygen-deprived tissue, and chest pain.  Severe episodes can even result in heart attacks (or permanently damaged heart muscle), with episodes occurring typically at rest, and not associated with physical exertion.   These spasms are often quite severe,  usually involve a single site in the coronary arteries, and tend to respond well to medications such as nitrates(nitro patch) and calcium channel blockers such as Diltiazem.  
The mechanism for Prinzemetal's angina is thought to involve an imbalance in the resting tone of the artery, with a propensity for constriction that isn't typically present.  Several factors that may exacerbate spasm, and which should definitely be avoided, include cigarettes, alcohol, and illicit cocaine use.   In many patients, the location of the coronary artery spasm is adjacent to an area of atherosclerotic blockage.  This suggests that traditional therapies to treat classic coronary artery disease may be useful here, and you would do well to consider therapy for elevated cholesterol, and aggressively treat any hypertension or diabetes that may be present.   These issues should be discussed with your doctor.  
I have one recommendation regarding the nitroglycerine patch.  Since most patients experience episodes of Prinzemetal's angina attacks during the night hours, you might want to wear the patch overnight, and remove it for a period of 8-10 hours during the day.  Finally, I can reassure you that the prognosis for isolated Prinzemetal's angina is excellent, with over 90% of patients doing well five years after the diagnosis.  
There are literally hundreds of references in the medical literature on this topic.  I'll suggest two of them, which you can obtain at a medical library.  You might also ask the librarian for help to conduct a search of the Medline database for a Review on this topic.  This literature is quite technical, and in the absence of a medical background, a good review article would be the best way to go.
1) Circulation  69; 880, 1984, Clinical Characteristics of Variant Angina
2) Circulation 78:1, 1988, Long-term Prognosis for Patients with Variant Angina.
I hope I've been of help.  Information provided in the Medhelp forum is for general purposes only. Specific diagnoses and therapy can only be made by your physician.