Vasospastic angina: pathophysiology and clinical significance
Open Access
- 4 March 2020
- journal article
- Published by Silicea - Poligraf, LLC in Cardiovascular Therapy and Prevention
- Vol. 19 (1), 99-105
- https://doi.org/10.15829/1728-8800-2020-1-99-105
Abstract
The review discusses an analysis of the literature on various aspects of the pathogenesis, diagnosis and treatment of vasospastic angina (VA). Data on the prevalence of coronary artery spasm (CAS) in various populations, as well as risk factors and triggers, are presented. We considered pathophysiological mechanisms of CAS, including hyperreactivity of coronary smooth muscle cells, endothelial dysfunction, nonspecific inflammation, oxidative stress, magnesium deficiency, autonomic imbalance, etc. The relationship of CAS with coronary atherosclerosis and thrombosis is emphasized. Modern recommendations for the diagnosis and treatment of VA are presented. Invasive verification of CAS is performed by pharmacological provocation tests with certain contraindications. Calcium antagonists and their combination with long-acting nitrates play a key role in the treatment of VA. Medications with a prospect for use in VA are Rho-kinase inhibitors, ATP-sensitive potassium channel activators, alpha-1 blockers. The management of patients with refractory VA and the prospects for endovascular treatment are discussed. It was noted that patients with multi-vessel VA are more likely to develop life-threatening arrhythmias and sudden death.Keywords
This publication has 50 references indexed in Scilit:
- Coronary artery spasm — Clinical features, pathogenesis and treatment —Proceedings of the Japan Academy, Series B, 2019
- Vasospastic angina: A literature review of current evidenceArchives of Cardiovascular Diseases, 2018
- Patients with acute myocardial infarction and non-obstructive coronary arteries: safety and prognostic relevance of invasive coronary provocative testsEuropean Heart Journal, 2017
- Clinical Features and Prognosis of Patients With Coronary Spasm–Induced Non–ST‐Segment Elevation Acute Coronary SyndromeJournal of the American Heart Association, 2014
- Guidelines for Diagnosis and Treatment of Patients With Vasospastic Angina (Coronary Spastic Angina) (JCS 2013)Circulation Journal, 2014
- 2013 ESC guidelines on the management of stable coronary artery diseaseEuropean Heart Journal, 2013
- High Prevalence of a Pathological Response to Acetylcholine Testing in Patients With Stable Angina Pectoris and Unobstructed Coronary Arteries: The ACOVA Study (Abnormal COronary VAsomotion in patients with stable angina and unobstructed coronary arteries)Journal of Invasive Cardiology, 2012
- Mechanisms of Coronary Artery SpasmJournal of the American College of Cardiology, 2011
- Interactions among gender, age, hypertension and C‐reactive protein in coronary vasospasmEuropean Journal of Clinical Investigation, 2010
- Angina pectoris I. A variant form of angina pectoris: Preliminary reportThe American Journal of Medicine, 1959