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Coronary Vasospasm: Is it a Myth?

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Abstract

This review addresses some myths about coronary vasospasm as the cause of angina pectoris. Coronary artery vasospasm is a common phenomenon, which is clinically encountered by busy cardiologists almost on a daily basis. It is the cause of resting angina in many patients without significant coronary artery disease, but also in patients with atherosclerotic coronary artery disease but no subtotal lesion. Although coronary artery vasospasm can be suspected clinically, proof cannot usually be obtained by non-invasive means but is easily available during cardiac catheterization. Patients with vasospastic angina are repeatedly exposed to this invasive procedure as most cardiologists suspect a coronary lesion requiring intervention as the cause of the patient’s resting angina. Adding an intracoronary acetylcholine test to the catheterization procedure may establish the correct diagnosis and enable treatment with calcium antagonists and nitrates. Epicardial vasospasm may be observed during the test in patients with and without angiographically visible lesions in the coronary arteries. Almost 50% of all pathological tests, however, do not show epicardial vasospasm but reproduction of symptoms and electrocardiogram signs of ischemia indicating spasm of the microvessels.

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Acknowledgements

The authors would like to thank Tracy Harrison of inScience Communications, a Wolters Kluwer business, who assisted with native English editing and journal styling before submission. This assistance was funded by Pfizer. None of the authors have any conflicts of interest that are directly relevant to the content of this review.

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Authors and Affiliations

  1. Department of Cardiology, Robert-Bosch-Krankenhaus, Auerbachstrasse 110, D-70376, Stuttgart, Germany

    Udo Sechtem, Peter Ong, Anastasios Athanasiadis, Matthias Vöhringer, Rimma Merher & Ali Yilmaz

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  1. Udo Sechtem
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  2. Peter Ong
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  3. Anastasios Athanasiadis
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  4. Matthias Vöhringer
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Correspondence to Udo Sechtem.

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Sechtem, U., Ong, P., Athanasiadis, A. et al. Coronary Vasospasm: Is it a Myth?. Am J Cardiovasc Drugs 10 (Suppl 2), 19–26 (2010). https://doi.org/10.2165/1153642-S0-000000000-00000

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