Ver el código de «Coronary artery vasospasm»

==Background==
*Typically affects patients <50 yo
*A/w transient ST deviation in local distribution
*Often occurs in early morning <ref> Prinzmetal M, Kennamer R, Merliss R, Wada T, Bor N. Angina pectoris. I. A variant form of angina pectoris; preliminary report. Am J Med. 1959;27:375-88.</ref>
*Mechanism is likely vagal withdrawal
*Tobacco use a major risk factor<ref> Takaoka K. Comparison of the risk factors for coronary artery spasm with those for organic stenosis in a Japanese population: role of cigarette smoking. Int J Cardiol. 2000;72:121–126.</ref>
*May be a/w migraines <ref> Rosamond W. Are migraine and coronary heart disease associated? An epidemiologic review. Headache. 2004;44 Suppl 1:S5-12. </ref>
*Vfib, tachycardia, and complete AV block may be a/w ischemic episodes

==Clinical Features==
*Chest discomfort/tightness/pressure
*Gradual onset/resolution
*Often no exertional component to CP
*No respirophasic component to pain
*Poorly localized; radiation of pain is common
*a/w nausea, diaphroesis, and palpations
*Attacks may be precipitated by hyperventilation

==Differential Diagnosis==
{{Chest Pain DDX}}

==Diagnosis==
*EKG
*CXR
*Holter monitor
*Stress testing typically done to evaluate for fixed CAD, though prinzmetal angina often yields negative results
**Often yields negative results <ref>Stern SS. Coronary artery spasm: a 2009 update.. Circulation (New York, N.Y.). 2009-05;119:2531-2534.</ref>
*Coronary angiography considered in following patients:<ref> Montalescot G, Sechtem U, Achenbach S, et al. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J. 2013;34(38):2949-3003.</ref>
**ECG with STE
**History strongly indicative and stress testing/ambulatory monitoring are normal

==Management==
*SLN
*Counsel on smoking cessation
*For chronic management
**Diltiazem 240-360 mg/day
**Isosorbide mononitrate considered 2nd line due to adverse effect profile
*Avoid nonselective beta blockers as they may exacerbate vasospasm <ref>Robertson RM, Wood AJ, Vaughn WK, Robertson D. Exacerbation of vasotonic angina pectoris by propranolol. Circulation. 1982;65(2):281-5. </ref>
*ASA used with caution and at low dose in pts without h/o CAD <ref>Miwa K, Kambara H, Kawai C. Effect of aspirin in large doses on attacks of variant angina. Am Heart J. 1983;105(2):351-5.</ref>

==Disposition==


==See Also==
*[[Cocaine chest pain]]
*[[Acute Coronary Syndrome (Main)]]

==External Links==


==References==
<references/>

[[Category:Cards]]