Vasospastic angina

Question 1

General findings (attenzione, riguarda il microcircolo)

Answer 1

Description:

Angina caused by transient coronary spasms (usually occurring close to areas of coronary stenosis)
Unrelated to exertion and may even occur AT REST (classically at night)
Epidemiology: average onset around 50 years

Prognosis:
The five-year survival rate is > 90% (with treatment).
Persistence of symptoms is common.

Question 2

Eziologia

Answer 2

-e.g., cigarette smoking, use of stimulants (e.g., cocaine, amphetamines) or sumatriptan, alcohol, stress, hyperventilation, exposure to cold.
There is an association with other disorders involving vasospasms (e.g., Raynaud phenomenon, migraine headaches)

Question 3

Diagnosi

Answer 3

• Reversible ST elevation on ECG
• No troponin I or T level elevations on serial measurements
• Coronary spasms on angiography confirm the diagnosis

Question 4

Trattamento

Answer 4

-Risk factor modification
-Calcium channel blockers and nitrates: first-line agent for acute attacks and prophylaxis, VERAPAMIL
Avoid beta-blockers! (vale lo stesso anche nelle patologie costrittive periferiche e nel fenomeno di Raynaud, perchè i bb hanno come effetto avverso la vasocostrizione)