Coronary artery spasm; clinical manifestations and angiographic correlates
Cardiologists commonly encounter patients with angina-like chest pain and normal or nearly normal coronary arteriograms. Coronary artery spasm has been implicated as the cause of chest pain in less than 10% of such patients. The problem for the cardiologists, therefore, is to determine which patient with angina-like chest pain and normal coronary arteriograms is experiencing coronary artery spasm. The diagnosis of coronary artery spasm can be strongly suspected because of the distinctive features that are usually found in such patients. Specific angiographic maneuvers, including the use of provocative tests for coronary artery spasm, are usually diagnostic in such patients.
The clinical presentation of patients who experience symptomatic coronary artery spasm is usually different from patients who suffer typical exertional angina. We analyzed the clinical presentation of 30 patients with symptomatic coronary artery spasm who had no fixed severe (more than 50%) coronary obstructions. All had positive provocative tests for coronary artery spasm. Our results are summarized in Table 1.
In the absence of angiographic demonstration of coronary artery spasm, the diagnosis is only presumptive. For this reason, we developed a provocative test for coronary artery spasm using ergonovine maleate. We found that this drug has a high degree of sensitivity and specificity in reproducing coronary artery spasm. The results of our initial study are listed in Table 2.
The incidence of symptomatic coronary artery spasm in the absence of fixed severe coronary obstructions is low, occurring in approximately one of 500 to 1000 patients studied for chest pain at the . . .