Invasive Evaluation for Coronary Vasospasm

Vasospastic angina (VSA) occurs at rest and on exertion, with transient electrocardiographic ischemic changes. VSA presents spontaneous coronary artery spasm (CAS); it has been associated stable angina, acute syndromes, sudden cardiac death. CAS can be identified in normal arteries or non-obstructive atherosclerosis, but is also prevalent patients disease. The diagnosis made invasive reactivity testing provocation using acetylcholine (Ach). Epicardial spasms visualized through angiography as a reversible epicardial vessel narrowing, while the of microvascular when symptoms ECG changes happen following intracoronary Ach without spasm. Identification allows for risk stratification specific therapies targeting endothelial dysfunction paradoxical vascular smooth muscle cell constriction. Therapies include calcium channel blockers monotherapy combination dihydropyridine non-dihydropyridine. Short-acting nitrates offer symptomatic relief long-acting should used sparingly. This current update evaluation discusses unified protocols.