Myocardial infarction with non-obstructive coronary arteries: a focus on vasospastic angina

M. A. Beijk, W. V. Vlastra, R. Delewi, T. P. van de Hoef, S. M. Boekholdt, K. D. Sjauw, J. J. Piek

Research output: Contribution to journalReview articleAcademicpeer-review

Abstract

Vasospastic angina (VSA) is considered a broad diagnostic category including documented spontaneous episodes of angina pectoris produced by coronary epicardial vasospasm as well as those induced during provocative coronary vasospasm testing and coronary microvascular dysfunction due to microvascular spasm. The hallmark feature of VSA is rest angina, which promptly responds to short-acting nitrates; however, VSA can present with a great variety of symptoms, ranging from stable angina to acute coronary syndrome and even ventricular arrhythmia. VSA is more prevalent in females, who can present with symptoms different from those among male patients. This may lead to an underestimation of cardiac causes of chest-related symptoms in female patients, in particular if the coronary angiogram (CAG) is normal. Evaluation for the diagnosis of VSA includes standard 12-lead ECG during the attack, Holter monitoring, exercise testing, and echocardiography. Patients suspected of having VSA with a normal CAG without a clear myocardial or non-cardiac cause are candidates for provocative coronary vasospasm testing. The gold standard method for provocative coronary vasospasm testing involves the administration of a provocative drug during CAG while monitoring patient symptoms, ECG and documentation of the coronary artery. Treatment of VSA consists of lifestyle adaptations and pharmacotherapy with calcium channel blockers and nitrates.
Original languageEnglish
Pages (from-to)237-245
JournalNetherlands Heart Journal
Volume27
Issue number5
DOIs
Publication statusPublished - 2019

Cite this

Beijk, M. A., Vlastra, W. V., Delewi, R., van de Hoef, T. P., Boekholdt, S. M., Sjauw, K. D., & Piek, J. J. (2019). Myocardial infarction with non-obstructive coronary arteries: a focus on vasospastic angina. Netherlands Heart Journal, 27(5), 237-245. https://doi.org/10.1007/s12471-019-1232-7
Beijk, M. A. ; Vlastra, W. V. ; Delewi, R. ; van de Hoef, T. P. ; Boekholdt, S. M. ; Sjauw, K. D. ; Piek, J. J. / Myocardial infarction with non-obstructive coronary arteries: a focus on vasospastic angina. In: Netherlands Heart Journal. 2019 ; Vol. 27, No. 5. pp. 237-245.
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abstract = "Vasospastic angina (VSA) is considered a broad diagnostic category including documented spontaneous episodes of angina pectoris produced by coronary epicardial vasospasm as well as those induced during provocative coronary vasospasm testing and coronary microvascular dysfunction due to microvascular spasm. The hallmark feature of VSA is rest angina, which promptly responds to short-acting nitrates; however, VSA can present with a great variety of symptoms, ranging from stable angina to acute coronary syndrome and even ventricular arrhythmia. VSA is more prevalent in females, who can present with symptoms different from those among male patients. This may lead to an underestimation of cardiac causes of chest-related symptoms in female patients, in particular if the coronary angiogram (CAG) is normal. Evaluation for the diagnosis of VSA includes standard 12-lead ECG during the attack, Holter monitoring, exercise testing, and echocardiography. Patients suspected of having VSA with a normal CAG without a clear myocardial or non-cardiac cause are candidates for provocative coronary vasospasm testing. The gold standard method for provocative coronary vasospasm testing involves the administration of a provocative drug during CAG while monitoring patient symptoms, ECG and documentation of the coronary artery. Treatment of VSA consists of lifestyle adaptations and pharmacotherapy with calcium channel blockers and nitrates.",
author = "Beijk, {M. A.} and Vlastra, {W. V.} and R. Delewi and {van de Hoef}, {T. P.} and Boekholdt, {S. M.} and Sjauw, {K. D.} and Piek, {J. J.}",
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Beijk, MA, Vlastra, WV, Delewi, R, van de Hoef, TP, Boekholdt, SM, Sjauw, KD & Piek, JJ 2019, 'Myocardial infarction with non-obstructive coronary arteries: a focus on vasospastic angina' Netherlands Heart Journal, vol. 27, no. 5, pp. 237-245. https://doi.org/10.1007/s12471-019-1232-7

Myocardial infarction with non-obstructive coronary arteries: a focus on vasospastic angina. / Beijk, M. A.; Vlastra, W. V.; Delewi, R.; van de Hoef, T. P.; Boekholdt, S. M.; Sjauw, K. D.; Piek, J. J.

In: Netherlands Heart Journal, Vol. 27, No. 5, 2019, p. 237-245.

Research output: Contribution to journalReview articleAcademicpeer-review

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AU - Vlastra, W. V.

AU - Delewi, R.

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AU - Piek, J. J.

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AB - Vasospastic angina (VSA) is considered a broad diagnostic category including documented spontaneous episodes of angina pectoris produced by coronary epicardial vasospasm as well as those induced during provocative coronary vasospasm testing and coronary microvascular dysfunction due to microvascular spasm. The hallmark feature of VSA is rest angina, which promptly responds to short-acting nitrates; however, VSA can present with a great variety of symptoms, ranging from stable angina to acute coronary syndrome and even ventricular arrhythmia. VSA is more prevalent in females, who can present with symptoms different from those among male patients. This may lead to an underestimation of cardiac causes of chest-related symptoms in female patients, in particular if the coronary angiogram (CAG) is normal. Evaluation for the diagnosis of VSA includes standard 12-lead ECG during the attack, Holter monitoring, exercise testing, and echocardiography. Patients suspected of having VSA with a normal CAG without a clear myocardial or non-cardiac cause are candidates for provocative coronary vasospasm testing. The gold standard method for provocative coronary vasospasm testing involves the administration of a provocative drug during CAG while monitoring patient symptoms, ECG and documentation of the coronary artery. Treatment of VSA consists of lifestyle adaptations and pharmacotherapy with calcium channel blockers and nitrates.

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