Coronary artery spasms happen when the walls of blood vessels squeeze together. This causes part of the blood vessel to narrow.

These spasms are not always severe or even painful. Sometimes, however, they can lead to serious problems, including chest pain, heart attack, or even death.

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

There are many options available to help treat the symptoms and underlying causes.

In this article, learn more about the symptoms, causes, risk factors, treatment options, and outlook associated with coronary artery spasms.

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A coronary artery spasm is also known as vasospastic angina or Prinzmetal angina. It occurs when a segment of an artery, which carries blood to the heart, tightens and narrows. The wall of the artery is muscular, and the muscle can spasm or tighten, just like any other muscle in the body.

As the artery spasms, the heart is forced to work harder to pump blood through the affected area. Spasms are usually brief, but they can last for more than 15 minutes in some cases.

It can be challenging for doctors to diagnose coronary artery spasms. A person with coronary artery spasms may not experience any symptoms. Alternatively, if they do have symptoms, unless a doctor conducts a testing procedure during the actual spasm, it can be difficult to link the symptoms to the issue.

As a result, according to some reviews, it is hard to determine the prevalence of the condition in the general population.

Symptoms can vary among people and often among occurrences. They can be so mild that a person may not realize that they are experiencing a spasm at all, or they can be so severe that they are physically disabling.

Coronary artery spasms differ from traditional chest pain primarily because they can happen when a person is at rest rather than exerting. In fact, some research suggests that a person is most likely to experience symptoms of coronary artery spasms between midnight and early morning.

What does it feel like?

When symptoms do occur, they can include symptoms of heart attack, such as:

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

Severity

In severe cases, a person may experience intense, prolonged chest pain accompanied by a cold sweat, nausea, or vomiting. They may also experience a temporary loss of consciousness. A person who is experiencing a coronary artery spasm may also feel muscular pain in their arm or jaw.

Alternatively, a person may experience mild versions of these symptoms or no symptoms at all. This may mask a serious condition.

According to one review, the incidence of cases in which a coronary artery spasm blocks blood flow to the heart with no visible symptoms is more than two times higher than cases in which the symptoms are obvious. However, the spasm is still causing problems with blood flow to the heart muscle.

The causes of coronary artery spasms are complex and multifaceted. The body’s automatic nervous system, a person’s level of chronic inflammation, and any underlying heart conditions they have may all play a part in causing coronary artery spasms, according to one 2020 review.

Many other bodily mechanisms may be involved, depending on a person’s unique physical state.

In addition, there may be triggers. These may include:

  • smoking
  • having exposure to cold
  • experiencing anxiety or stress
  • exercising, especially early in the morning
  • using vasoconstrictor drugs, including certain types of beta-blockers, which can worsen spasms
  • using cannabis or cocaine and other stimulant drugs
  • drinking alcohol
  • taking the weight loss drug phentermine

Some research into coronary artery spasms has also identified many factors that can increase a person’s risk of the condition.

Many of the triggers are also risk factors, but there are several others. They include:

Stress and other mental health factors can also affect a person’s risk of coronary artery spasms. However, existing research into this topic is inconclusive, so further study is necessary.

The condition reportedly affects females more often than males. Also, people who get coronary artery spasms may be younger and exhibit fewer of the typical risk factors for cardiovascular problems, with the exception of smoking.

On the other hand, the condition may be associated with other conditions that cause the narrowing of blood vessels, such as Raynaud’s phenomenon, and migraine.

There are three main tests a doctor can conduct to diagnose coronary artery spasm. These are:

  • Coronary angiography: This is an X-ray-like test that creates images of the blood vessels.
  • Electrocardiogram: This is a test that checks for unusual electrical patterns in the heart.
  • Echocardiogram: This technique uses ultrasound technology to examine heart valves and blood flow.

These tests may reveal symptoms of coronary artery spasms. However, the best way for a doctor to diagnose the condition definitively is by doing an additional test called provocative testing.

During provocative testing, the doctor uses specific drugs to provoke a spasm, which allows them to diagnose the condition with certainty.

There is currently no single cure for a coronary artery spasm, but there are several ways to manage the condition and reduce the symptoms it causes.

Quitting smoking is the most helpful lifestyle change a person can make to reduce the symptoms. A person may also be able to reduce their risk of repeat spasms by making changes to their activity levels and diet.

A doctor may also prescribe certain medications to manage coronary artery spasms, including:

  • calcium channel blockers to reduce muscle tightening in the arteries
  • nitrates to ease chest pain
  • statins to lower cholesterol and strengthen the arteries
  • magnesium, if the person has low magnesium levels

When medications and lifestyle changes do not work, a doctor may recommend more invasive procedures to treat the condition.

Although it may not always be possible to predict coronary artery spasms, eliminating some of the risk factors and triggers may help reduce the risk.

Because smoking is one of the most significant risk factors, a person can try to reduce smoking or quit altogether. Similarly, reducing or eliminating the intake of alcohol may also help with prevention.

Since most coronary artery spasms happen at rest, unlike many other heart complications, a person usually does not have to stop or limit physical activity as a preventive measure. In fact, one 2016 review of vasospastic angina reported that aerobic exercise can lead to a reduction in blood flow-related heart conditions.

Once a doctor diagnoses this condition, they may recommend medications such as calcium channel blockers, nitrates, and statins to prevent further symptoms.

Medications to avoid

A person with coronary heart spasms should avoid or limit their use of the following drugs:

  • Nonselective beta-blockers: These drugs, which include propranolol, may exacerbate coronary artery spasms.
  • Aspirin: At high doses, these drugs inhibit prostacyclin production. However, a person with coronary heart spasms may be able to take the medication at low doses with caution and while under medical supervision. People with coronary heart disease may take 75–81 milligrams of aspirin daily.
  • Oral sumatriptan: This drug treats acute migraine. However, its use may be associated with coronary vasospasm and heart attack. A person may want to avoid all medications of the triptan class if they have known or suspected coronary artery spasms.
  • Fluorouracil: Also known as 5-fluorouracil, this drug may induce coronary artery spasms.

Without treatment, coronary artery spasms may occur more frequently and can lead to further complications, such as heart attack, heart failure, and sudden death.

The likelihood of complications may also increase if a person has other underlying heart conditions, such as coronary heart disease.

Coronary artery spasms can also cause different forms of arrhythmia, which refers to a change in the way that the heart beats.

Learn more about arrhythmia here.

According to some reviews, the long-term outlook for people who experience coronary artery spasms without other underlying heart conditions is good.

Medication can usually help people control spasms and the symptoms they cause over time. A person should continue with their prescribed medications or treatments even if they no longer experience any symptoms of coronary artery spasms.

Making lifestyle changes can also improve a person’s outlook. For example, avoiding smoking is a critical factor in reducing episodes of coronary artery spasms.