Вазоспастична стенокардія

Symptoms are anginal discomfort occurring mainly during rest, often at night, and only rarely and inconsistently during exertion (unless significant coronary artery obstruction is also present). Attacks tend to occur regularly at certain times of day.

• Provocative testing with ergonovine or acetylcholine during angiography

Diagnosis of vasospastic angina is suspected if ST-segment elevation occurs during an attack. Between anginal attacks, the ECG may be normal or show a stable abnormal pattern.

Confirmation is by provocative testing with ergonovine or acetylcholine, which may precipitate coronary artery spasm. Coronary artery spasm is identified by finding significant ST-segment elevation on ECG or by observation of a reversible spasm during cardiac catheterization. Testing is done most commonly in a cardiac catheterization laboratory.

• Calcium channel blockers

• Sublingual nitroglycerin

Usually, sublingual nitroglycerin promptly relieves vasospastic angina. Calcium channel blockers may effectively prevent symptoms. Theoretically, beta-blockers (other than labetalol and carvedilol) may exacerbate spasm by allowing unopposed alpha-adrenergic vasoconstriction, but this effect has not been proven clinically.

Oral medications most commonly used are calcium channel blockers:

• Sustained-release diltiazem

• Sustained-release verapamil

• Amlodipine

Although all these medications relieve symptoms, they do not appear to alter prognosis. Average survival at 5 years is approximately 95% (if obstruction is absent or present in only one vessel), but mortality risk is greater for patients with both vasospastic angina and atherosclerotic coronary artery obstruction (1, 2). Risk increases with increasing obstruction.