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| {{Chronic stable angina}}
| | #redirect:[[Coronary vasospasm]] |
| {{CMG}}; '''Associate Editor-In-Chief:''' [[Lakshmi Gopalakrishnan]], M.B.B.S.
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| '''''Synonyms and related keywords:''''' vasospastic angina, variant angina, prinzmetal's angina
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| ==Overview==
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| *Patients who experience [[angina]] at rest can be relieved by [[nitrates]].
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| *'''Coronary artery spasm''' due hyperreactivity of the involved smooth muscle cells is considered to be the underlying mechanism responsible for variant angina.
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| *A significant group of patients with variant angina have '''obstructive coronary artery disease.'''<ref name="pmid727129">Maseri A, Severi S, Nes MD, L'Abbate A, Chierchia S, Marzilli M et al. (1978) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=727129 "Variant" angina: one aspect of a continuous spectrum of vasospastic myocardial ischemia. Pathogenetic mechanisms, estimated incidence and clinical and coronary arteriographic findings in 138 patients.] ''Am J Cardiol'' 42 (6):1019-35. PMID: [http://pubmed.gov/727129 727129]</ref>
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| *Precipitating factors for [[vasospasm]] are:
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| ::*cold stimulation
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| ::*[[smoking]]
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| ::*[[cocaine]] use
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| ::*electrolyte disturbances (potassium, magnesium)
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| ::*autoimmune diseases
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| ::*[[hyperventilation]]
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| ::*[[insulin resistance]]
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| ::*higher prevalence in Japanese populations.
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| *[[ST elevation]] is classically observed on [[ECG]] during an episode of [[vasospasm]].
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| *Intracoronary [[acetylcholine]] or [[ergonovine]] provocation test is used to diagnose [[vasospasm]].
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| *The prognosis of vasospastic angina depends on the extent of underlying [[CAD]].
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| ==ESC Guidelines for diagnostic tests in suspected vasospastic angina (DO NOT EDIT)<ref name="pmid16735367">{{cite journal| author=Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F et al.| title=Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology. | journal=Eur Heart J | year= 2006 | volume= 27 | issue= 11 | pages= 1341-81 | pmid=16735367 | doi=10.1093/eurheartj/ehl001 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16735367 }} </ref>==
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| {{cquote|
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| ===Class I===
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| '''1.''' ECG during [[angina]] if possible. ''(Level of Evidence: B)''
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| '''2.''' Coronary arteriography in patients with characteristic episodic [[chest pain]] and ST-segment changes that resolve with [[nitrates]] and/or [[calcium channel blockers]] to determine the extent of underlying coronary disease. ''(Level of Evidence: B)''
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| ===Class IIa===
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| '''1.''' Intracoronary provocative testing to identify coronary spasm in patients with normal findings or nonobstructive lesions on coronary arteriography and the clinical picture of coronary spasm. ''(Level of Evidence: B)''
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| '''2.''' [[Chronic stable angina ambulatory ST segment monitoring|Ambulatory ST Segment Monitoring]] to identify ST-deviation. ''(Level of Evidence: C)''}}
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| ==ESC Guidelines for pharmacological therapy of vasospastic angina (DO NOT EDIT)<ref name="pmid16735367">{{cite journal| author=Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F et al.| title=Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology. | journal=Eur Heart J | year= 2006 | volume= 27 | issue= 11 | pages= 1341-81 | pmid=16735367 | doi=10.1093/eurheartj/ehl001 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16735367 }} </ref>==
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| {{cquote|
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| ===Class I===
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| '''1.''' Treatment with [[calcium channel blocker]] and if necessary [[nitrates]] in patients whose coronary arteriogram is normal or shows only non-obstructive lesions. ''(Level of Evidence: B)''}}
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| ==Sources==
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| *Guidelines on the management of stable angina pectoris: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology <ref name="pmid16735367">{{cite journal| author=Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F et al.| title=Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology. | journal=Eur Heart J | year= 2006 | volume= 27 | issue= 11 | pages= 1341-81 | pmid=16735367 | doi=10.1093/eurheartj/ehl001 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16735367 }} </ref>
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| ==References==
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| {{reflist|2}}
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| [[Category:Disease state]]
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| [[Category:Ischemic heart diseases]]
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| [[Category:Cardiology]]
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| [[Category:Emergency medicine]]
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