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Arch Cardiovasc Dis. 2019 Jan;112(1):44-55. doi: 10.1016/j.acvd.2018.08.002. Epub 2018 Sep 7.

Vasospastic angina: A literature review of current evidence.

Author information

1
Cardiology department, hôpital Cochin, AP-HP, 75014 Paris, France; Faculté de médecine, université Paris Descartes, 75006 Paris, France. Electronic address: fabien.picard@aphp.fr.
2
Cardiology department, hôpital Cochin, AP-HP, 75014 Paris, France.
3
Cardiology department, centre hospitalier affilié universitaire régional (CHAUR) de Trois-Rivières, QC G8Z 3R9 Tois-Rivières, Canada.
4
Cardiology department, centre hospitalier universitaire Vaudois, 1011 Lausanne, Switzerland.
5
Cardiology department, hôpital Cochin, AP-HP, 75014 Paris, France; Faculté de médecine, université Paris Descartes, 75006 Paris, France.

Abstract

Vasospastic angina (VSA) is a variant form of angina pectoris, in which angina occurs at rest, with transient electrocardiogram modifications and preserved exercise capacity. VSA can be involved in many clinical scenarios, such as stable angina, sudden cardiac death, acute coronary syndrome, arrhythmia or syncope. Coronary vasospasm is a heterogeneous phenomenon that can occur in patients with or without coronary atherosclerosis, can be focal or diffuse, and can affect epicardial or microvasculature coronary arteries. This disease remains underdiagnosed, and provocative tests are rarely performed. VSA diagnosis involves three considerations: classical clinical manifestations of VSA; documentation of myocardial ischaemia during spontaneous episodes; and demonstration of coronary artery spasm. The gold standard diagnostic approach uses invasive coronary angiography to directly image coronary spasm using acetylcholine, ergonovine or methylergonovine as the provocative stimulus. Lifestyle changes, avoidance of vasospastic agents and pharmacotherapy, such as calcium channel blockers, nitrates, statins, aspirin, alpha1-adrenergic receptor antagonists, rho-kinase inhibitors or nicorandil, could be proposed to patients with VSA. This review discusses the pathophysiology, clinical spectrum and management of VSA for clinicians, as well as diagnostic criteria and the provocative tests available for use by interventional cardiologists.

KEYWORDS:

Angor; Angor vasospastique; Prinzmetal; Variant angina; Vasospasm; Vasospasme; Vasospastic angina

PMID:
30197243
DOI:
10.1016/j.acvd.2018.08.002
[Indexed for MEDLINE]

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