Makindo Medical Notes.com

Beta blockers are avoided as particularly non-selective ones, can potentially exacerbate coronary artery spasms by allowing unopposed alpha-adrenergic receptor activity.

About

• Cause of chest pain and ST elevation

Aetiology

• Focal or diffuse Coronary vasospasm leading to a temporary reduction in blood flow
• There may be a fixed atherosclerotic lesion (75% of cases)
• Can also occur in normal coronary arteries
• Hyperreactivity of the coronary artery smooth muscle

Clinical

• Chest Pain: severe, often at rest, and often in cycles, particularly at night or in the early morning hours.
• Duration: The pain is usually short-lived, lasting less than 15 minutes.
• Relief: The pain often resolves spontaneously or with the use of nitroglycerin.
• Associated Symptoms: Palpitations, dyspnoea, dizziness.

Differentials

• Ischaemic heart disease

Investigations

• Bloods: FBC, U&E, LFTs, Troponin
• Electrocardiogram (ECG): ST-segment elevation that promptly responded to sublingual nitrates
• Coronary Angiography: is a definitive test-displays coronary vasospasm. Spasm and chest pain with IV ergonovine or acetylcholine.
• Holter Monitoring: episodes of ST-segment elevation during symptoms.

Management: Treat as Acute coronary syndrome

• Short acting Nitrates: Sublingual GTN/NTG to relieve acute chest pain episodes
• Beta blockers: are generally avoided
• Calcium channel blockers: such as diltiazem or verapamil are useful
• Long acting Nitrates: have been proven to be helpful
• Manage risks: smoking cessation and lipid-lowering where appropriate, avoid stress, cold exposure
• Statins: May be used if there is underlying atherosclerosis to help stabilize plaques.
• Treat: coexisting cardiac disease as needed