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IF someone experiences gripping chest pain similar to angina, but specialized X-ray imaging (coronary angiogram) failed to demonstrate narrowing or blockages in the coronary arteries that supply one’s heart with blood, one possible cause is coronary artery spasm, says the April 2011 issue of the Mayo Clinic’s Health Letter.

Coronary artery spasm, a brief, temporary narrowing or contraction of an artery that supplies blood to your heart which can cause symptoms of angina, such as chest tightness or pressure...or a crushing, squeezing chest pain...can also trigger a heart attack or a life-threatening heart rhythm disturbance (arrhythmia), adds the health letter.

In fact, repeated episodes of coronary artery spasm can result in a deterioration of heart function, setting the stage for heart failure.

While it is often considered a problem of younger adults, it can also occur in older adults (particularly in older women), where the problem is more apt to occur in those with coronary artery disease that may not be detectable with a typical coronary angiogram test.

It may be extremely difficult to distinguish angina caused by narrowed arteries due to coronary artery disease (the most common cause of angina) from angina caused by coronary artery spasm, based on symptoms alone.

However, angina due to coronary artery spasm is more likely to occur at rest, or may be brought on by such triggers as exposure to cold, tobacco or emotional stress, says the letter.

The usual trigger points or factors associated with coronary artery spasms are the same factors that put you at risk of developing coronary artery disease, including:

• Exposure to cold

• Certain autoimmune diseases, such as lupus

• Migraines

• Extreme emotional stress, such as the death of a spouse

• A commonly used chemotherapy medication, 5-fluorouracil (5-FU) or its oral form capecitabine (Xeloda)

• Endothelial dysfunction — This is when the endothelial cells lining the inside of your heart arteries don’t perform their function of allowing arteries to properly expand (dilate)

Diagnosis of coronary artery spasm usually begins with a coronary angiogram.

If no blockages are found as the angiogram is being performed, doctors can administer a drug into your heart arteries that can briefly provoke a spasm, if you’re susceptible.

However, the lack of a demonstrable narrowing or blockages on an angiogram doesn’t mean you’re free of coronary artery disease.

As a matter of fact, coronary artery disease is often present at the site of coronary artery spasm, but in the early stages of coronary disease, vessels undergo mostly imperceptible changes and cholesterol-laden plaques initially grow outward on an artery, without causing narrowing, explains the letter.

Thus, additional testing may be done to identify endothelial dysfunction, which in older adults is commonly associated with coronary artery spasm.

Treatment of coronary artery spasm involves the aggressive modification of risk factors of heart disease and addressing underlying causes which may include:

• Not using tobacco products

• Getting regular exercise

• Eating a healthy diet

• Maintaining a healthy weight

• Managing stress

• Your doctor may recommend drugs to help control high blood pressure, cholesterol, diabetes or other risk factors

Additional drugs may be prescribed to more directly prevent artery spasm, such as:

1) Nitrates — These can help dilate arteries and relax artery walls and may be prescribed as a long-term medication and as a pill to have on hand, should another episode occur.

2) Calcium channel blockers — These drugs help relax artery muscles and are taken long term.

3) L-arginine — This supplement helps increase nitric acid, which may prevent spasms.

4) Cholesterol-lowering statins — These medications can also help improve endothelial function.

While many respond well to the first line measures, those with minimal coronary artery disease tend to do best, says the letter.

However, surgical procedures, such as placing a stent to prop open an area of spasm or implantation of an internal device (defibrillator) to stop a life-threatening arrhythmia may be considered on a case-by-case basis, concludes the health letter.

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