Cardiovascular ImagingCoronary artery spasm
dynamic narrowing of the coronary causing reduction of blood flow and angina pectoris. It occurs spontaneously and in response to several known stimuli.
Spasm occurs at the site of atherosclerotic
stenosis or at apparently normal segments of the coronary arteries. A form of angina associated with
spasm is called
Prinzmetals variant angina.
Spasm is one of several causes of
myocardial infarction in the presence of angiographically normal coronary arteries.
Coronary arteriography reveals a coronary arterial stenosis or occlusion which spontaneously resolves or is alleviated by nitroglycerin and other vasodilators (Fig.1). Coronary arterial spasm may be induced during angiography by the administration of low doses of a vasoconstrictor such as ergonovine test or with various manoeuvres such as cold immersion of a hand or hyperventilation. Catheter tip induced spasm of the proximal coronary artery is not uncommon. Spasm is frequently encountered after angioplasty and is reversed by nitroglycerin.
CBH
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Selective right coronary arteriogram in the right anterior oblique projection shows occlusion of the artery due to spasm (left) and relief of spasm after nitroglycerin (right). There is a residual fixed stenosis at the site of spasm. During spasm, the electrocardiogram demonstrated ST segment elevation in leads 2, 3 and aVF.
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Coronary artery spasm, Fig.1 | |