Let's be aware of Coronary Artery Spasm!

Have you ever had a sudden, squeezing, or constricting pain in your chest for no apparent reason, especially in the middle of the night or early morning? It goes away on its own after a while. While some people think this is normal, this is actually a health condition that we don't talk about much, but we should definitely be aware of. Today we are talking about this condition in which the blood vessels in the heart suddenly become constricted, or in medical terms, Coronary Artery Spasm .

Simply put, what is Coronary Artery Spasm?

To understand this, let's take a small example. Imagine a rubber pipe that carries water. Water flows through it without any obstruction. But what happens if someone suddenly squeezes the pipe tightly? The water flow either stops or decreases greatly, right? That's what happens in our hearts.

Our heart is a constantly working muscle. The oxygen and nutrients needed by this heart muscle are supplied by the coronary arteries , which are located on the surface of the heart. A coronary artery spasm is when the walls of these blood vessels suddenly contract or become blocked. It's like squeezing a water pipe.

This spasm temporarily blocks or obstructs blood flow to the heart. Most of the time, this spasm doesn't last long. Some people don't even notice it. However, if this condition happens frequently, it can increase the risk of serious conditions like a heart attack .

Is this the same as angina pain? What's the difference?

This is a question that many people ask. Angina is chest pain that occurs when the heart does not receive enough blood supply. The main and most common cause of this is the buildup of cholesterol (plaque) in the arteries of the heart, which causes the arteries to become blocked. We call this atherosclerosis . Usually, this type of angina pain occurs during exercise, when you are tired, or when you climb stairs. It decreases when you rest.

However, angina pain caused by coronary artery spasm is a little different. We call it Vasospastic Angina . The special thing about this is that this pain often comes when you are at rest, without any exertion. This pain can especially occur at night or in the early morning. This is the main difference.

Who is most at risk for this condition?

The same risk factors that generally affect heart disease also affect this. That is:

• High blood pressure (Hypertension): High blood pressure means that the arteries are constantly damaged.
• High blood cholesterol levels (Hyperlipidemia): These deposits in the veins and reduce their flexibility.
• Smoking or using other tobacco products: This is the main and most serious risk factor . The chemical in tobacco called nicotine constricts blood vessels.
• Illegal drug use: especially stimulant drugs like cocaine.

What are the triggers for this spasm?

In addition to underlying risk factors, certain things can cause this blockage to start suddenly. We call these 'triggers'.

• Tobacco use: This can happen even after smoking a cigarette.
• Exposure to extreme cold: Things like taking a sudden shower with extremely cold water or going into a room with excessively hot AC.
• Extreme Stress: A sudden, intense feeling of anger, sadness, or pressure.
• Stimulants: Drugs such as amphetamines or cocaine.

What are the symptoms of this? How does it feel?

Some people may have this condition without any symptoms. But if symptoms do occur, you may experience things like:

• Chest tightness or tightness: It feels like your chest is being squeezed with a belt.
• Pain: Most of the time, the pain comes from the left side of the chest.
• Pain spreading: This pain can start in the chest and spread to the neck, jaw, shoulders, or arms.
• Pain while resting: This pain can occur especially after midnight or in the early morning and can wake you up from sleep.

This spasm can last from as little as 5 minutes to as long as 30 minutes. For some people, it happens once or twice a year, while for others, it can happen several times a day.

How does a doctor diagnose this?

If you have these symptoms, you should definitely see your doctor . He or she will examine you and, if necessary, refer you for some of these tests.

• Electrocardiogram (EKG): This records the electrical activity of the heart, or the rhythm of the heartbeat. If an EKG is taken during a spasm, specific changes can be seen.
• Echocardiogram (Echo test): This is like an ultrasound scan of the heart. It can look at how the heart's chambers, valves, and heart muscle are working.
• Ambulatory Monitor: Your doctor may give you a small device to wear for a day or two. This is also called a Holter Monitor. It records your heart rate throughout the day while you are doing your normal activities. This is very important for detecting a spasm that occurs at night.
• Coronary Angiography: This is the best test to confirm this condition. In this test, a very thin tube is inserted through a vein in your arm or leg into the coronary arteries of your heart. Then, a special dye is injected into it, and an X-ray video is used to see how the blood flows. If the arteries are not blocked by cholesterol, a special drug that causes a spasm can be given during this test to see if the arteries are blocked.

What are the treatments? Can this be cured?

There are two main goals of treatment. One is to relieve pain, and the other is to prevent the spasm from recurring.

Emergency pain treatment

Nitroglycerin (Nitrostat®) is a medication used to relieve pain as soon as it occurs. It comes as a small tablet to be placed under the tongue or as a spray. It quickly dilates blood vessels, relieves congestion, and restores blood flow.

Long-term treatment

Your doctor will prescribe medication for you to take daily to prevent recurring spasms.

• Calcium Channel Blockers: Drugs like Amlodipine and Diltiazem belong to this group. These work by relaxing the muscles in the walls of blood vessels. This reduces the constriction of the veins.
• Statins: Drugs like Atorvastatin and Simvastatin. Although these are primarily used to lower cholesterol, they have also been found to help improve blood vessel function and prevent spasms.

In some severe cases, this spasm can cause the heart to beat dangerously irregularly. We call this Ventricular Arrhythmia . For those at risk, the doctor may recommend implanting a small device called an ICD (Implantable Cardioverter Defibrillator) under the skin of the chest. This detects when the heart is beating irregularly, sends a small electrical signal, and restores the rhythm.

When should you go to the hospital in an emergency?

This is very important. If a spasm lasts for too long, it can develop into a heart attack. Therefore, if you have one or more of the following symptoms along with chest pain, do not delay. Call an ambulance immediately or go to the nearest hospital's Emergency Treatment Unit (ETU).