Key result
Patients with multi-vessel vasospastic angina are more likely to develop life-threatening arrhythmias and sudden death, with calcium antagonists playing a key role in treatment.
This review summarizes the pathophysiology, diagnosis, and management of vasospastic angina, highlighting the central role of calcium antagonists and the increased risk of sudden death in multi-vessel disease.
The review discusses an analysis of the literature on various aspects of the pathogenesis, diagnosis and treatment of vasospastic angina (VA). Data on the prevalence of coronary artery spasm (CAS) in various populations, as well as risk factors and triggers, are presented. We considered pathophysiological mechanisms of CAS, including hyperreactivity of coronary smooth muscle cells, endothelial dysfunction, nonspecific inflammation, oxidative stress, magnesium deficiency, autonomic imbalance, etc. The relationship of CAS with coronary atherosclerosis and thrombosis is emphasized. Modern recommendations for the diagnosis and treatment of VA are presented. Invasive verification of CAS is performed by pharmacological provocation tests with certain contraindications. Calcium antagonists and their combination with long-acting nitrates play a key role in the treatment of VA. Medications with a prospect for use in VA are Rho-kinase inhibitors, ATP-sensitive potassium channel activators, alpha-1 blockers. The management of patients with refractory VA and the prospects for endovascular treatment are discussed. It was noted that patients with multi-vessel VA are more likely to develop life-threatening arrhythmias and sudden death.
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Geltser et al. (2020) conducted a review in Vasospastic angina. Patients with multi-vessel vasospastic angina are more likely to develop life-threatening arrhythmias and sudden death, with calcium antagonists playing a key role in treatment.
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