Coronary artery spasm is a temporary narrowing of the blood vessels that supply blood to the heart, causing ischemia and chest pain. It can be difficult to diagnose and treat, but medications and managing risk factors can help. Cocaine use can complicate the condition and should be disclosed to doctors.
Coronary artery spasm is a temporary narrowing of one of the coronary arteries, the blood vessels that supply blood to the heart. The constriction cuts off the blood supply to the heart, starving it of blood and causing ischemia. Coronary artery spasm can be “silent,” meaning the patient isn’t aware it’s happening, or it can cause sharp chest pain. When the artery relaxes and the spasm ends, the blood supply to the heart returns and the pain resolves, if the patient feels pain.
The cause of coronary artery spasm is not fully understood. It appears to be linked to risk factors such as smoking, high stress, high blood pressure and high cholesterol. Patients with a history of angina may also experience coronary artery spasm. In other patients, there are no obvious risk factors, and in fact the patient may be quite healthy when examined by a doctor. Spasms can recur at varying intervals throughout life.
Vasospasm, as blood vessel constrictions are known, can be difficult to treat and diagnose because once the spasm is over, the blood vessel returns to normal. In coronary artery spasm, a healthy or diseased blood vessel may be involved, but unless a doctor with imaging equipment is present when the spasm occurs, it may not be immediately identified. That’s why it’s important to report your chest pain to your doctor and describe its duration and details as fully as possible, as this will provide diagnostic clues that can be invaluable for treatment.
Once a doctor determines that a coronary artery spasm is occurring, steps can be taken to treat it. Certain medications can be used to manage coronary artery spasm, including beta-blockers and calcium channel blockers. If the patient has risk factors, managing these factors may also help. For example, lowering cholesterol can reduce the patient’s risk of coronary artery spasm.
In cases where the coronary arteries are diseased, surgery to perform a bypass may be performed to address the problems caused by the diseased vessels. This surgery is performed by a surgeon who specializes in heart procedures, and the prognosis for the patient after the surgery varies depending on many factors, including general health, extent of disease, and so on.
Patients should be aware that cocaine use can complicate coronary artery spasm and that cocaine can interact poorly with some of the drugs used to manage this condition. Cocaine users should disclose their drug use to their doctors; a doctor will not report a patient’s drug use to anyone, but the information is highly relevant to treatment, and a patient could die from complications associated with cocaine use if a doctor is not notified.
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