Coronary Vasospastic Angina: A Review of the Pathogenesis, Diagnosis, and Management
Vasospastic angina (VSA) is an under-appreciated cause of chest pain. It is characterised by transient vasoconstriction of the coronary arteries and plays a significant role in the pathogenesis of stable angina and acute coronary syndromes. Complex mechanistic pathways characterised by endothelial d...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-07-01
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| Series: | Life |
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| Online Access: | https://www.mdpi.com/2075-1729/12/8/1124 |
| _version_ | 1797444057958449152 |
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| author | Rajan Rehan James Weaver Andy Yong |
| author_facet | Rajan Rehan James Weaver Andy Yong |
| author_sort | Rajan Rehan |
| collection | DOAJ |
| description | Vasospastic angina (VSA) is an under-appreciated cause of chest pain. It is characterised by transient vasoconstriction of the coronary arteries and plays a significant role in the pathogenesis of stable angina and acute coronary syndromes. Complex mechanistic pathways characterised by endothelial dysfunction and smooth muscle hypercontractility lead to a broad spectrum of clinical manifestations ranging from recurrent angina to fatal arrhythmias. Invasive provocation testing using intracoronary acetylcholine or ergonovine is considered the current gold standard for diagnosis, but there is a wide variation in protocols amongst different institutions. Conventional pharmacological therapy relies on calcium channel blockers and nitrates; however, refractory VSA has limited options. This review evaluates the pathophysiology, diagnostic challenges, and management strategies for VSA. We believe global efforts to standardise diagnostic and therapeutic guidelines will improve the outcomes for affected patients. |
| first_indexed | 2024-03-09T13:06:05Z |
| format | Article |
| id | doaj.art-d40d7a77ae6044a3964b3e6fa6e22043 |
| institution | Directory Open Access Journal |
| issn | 2075-1729 |
| language | English |
| last_indexed | 2024-03-09T13:06:05Z |
| publishDate | 2022-07-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Life |
| spelling | doaj.art-d40d7a77ae6044a3964b3e6fa6e220432023-11-30T21:48:48ZengMDPI AGLife2075-17292022-07-01128112410.3390/life12081124Coronary Vasospastic Angina: A Review of the Pathogenesis, Diagnosis, and ManagementRajan Rehan0James Weaver1Andy Yong2Concord Repatriation Hospital, Sydney, NSW 2137, AustraliaRoyal Prince Alfred Hospital, Sydney, NSW 2050, AustraliaConcord Repatriation Hospital, Sydney, NSW 2137, AustraliaVasospastic angina (VSA) is an under-appreciated cause of chest pain. It is characterised by transient vasoconstriction of the coronary arteries and plays a significant role in the pathogenesis of stable angina and acute coronary syndromes. Complex mechanistic pathways characterised by endothelial dysfunction and smooth muscle hypercontractility lead to a broad spectrum of clinical manifestations ranging from recurrent angina to fatal arrhythmias. Invasive provocation testing using intracoronary acetylcholine or ergonovine is considered the current gold standard for diagnosis, but there is a wide variation in protocols amongst different institutions. Conventional pharmacological therapy relies on calcium channel blockers and nitrates; however, refractory VSA has limited options. This review evaluates the pathophysiology, diagnostic challenges, and management strategies for VSA. We believe global efforts to standardise diagnostic and therapeutic guidelines will improve the outcomes for affected patients.https://www.mdpi.com/2075-1729/12/8/1124coronary artery vasospasmvasospastic anginaendothelial dysfunctionintracoronary provocation testing |
| spellingShingle | Rajan Rehan James Weaver Andy Yong Coronary Vasospastic Angina: A Review of the Pathogenesis, Diagnosis, and Management Life coronary artery vasospasm vasospastic angina endothelial dysfunction intracoronary provocation testing |
| title | Coronary Vasospastic Angina: A Review of the Pathogenesis, Diagnosis, and Management |
| title_full | Coronary Vasospastic Angina: A Review of the Pathogenesis, Diagnosis, and Management |
| title_fullStr | Coronary Vasospastic Angina: A Review of the Pathogenesis, Diagnosis, and Management |
| title_full_unstemmed | Coronary Vasospastic Angina: A Review of the Pathogenesis, Diagnosis, and Management |
| title_short | Coronary Vasospastic Angina: A Review of the Pathogenesis, Diagnosis, and Management |
| title_sort | coronary vasospastic angina a review of the pathogenesis diagnosis and management |
| topic | coronary artery vasospasm vasospastic angina endothelial dysfunction intracoronary provocation testing |
| url | https://www.mdpi.com/2075-1729/12/8/1124 |
| work_keys_str_mv | AT rajanrehan coronaryvasospasticanginaareviewofthepathogenesisdiagnosisandmanagement AT jamesweaver coronaryvasospasticanginaareviewofthepathogenesisdiagnosisandmanagement AT andyyong coronaryvasospasticanginaareviewofthepathogenesisdiagnosisandmanagement |