Vasospastic Angina

by Carlo Raj, MD

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    Welcome to vasospastic angina. A third and final type of angina, we, up until this point have categorized angina as being chest pain, depending as to whether or not there is rest or upon exertion. And I told you at the time that when we were discussing unstable and stable angina, that we would leave vasospastic separately because it doesn't necessarily fall into the same pathogenesis of stable, unstable and then MI. The spectrum that we had walked through there and you want to make sure that you travelled through that pathogenesis so that as you go through it, you are integrating the physio; you are looking at the disease and then how do you want to manage your patient. With stable angina, do you remember that patient? There is chest pain upon exertion, nitroglycerin so that you can relieve some of that pain. And so by doing so, you are decreasing the preload, decreasing the afterload and making it much easier for the heart to then function. Correct? Unstable angina. My goodness now the atherosclerotic plaque, key point, atherosclerosis. The plaque is getting bigger. We went through the pathogenesis of that and then remember the cardiac enzymes were negative, black and white. Keep things simple so that at least you have a definitive answer and you are confident with your response. Now clinically, there is always room for overlapping in that gray area, but at this point let us just keep things very straightforward. So with vasospastic as the name implies, formerly known as Printz medal, maybe you have known it as being variant, but a much more clinically relevant term would be vasospastic. That's exactly what is occurring in your coronary artery. Let us take a look. With focal coronary artery spasm, the operative word here is spasm....

    About the Lecture

    The lecture Vasospastic Angina by Carlo Raj, MD is from the course Ischemic Heart Disease. It contains the following chapters:

    • Pathogenesis
    • Diagnosis

    Included Quiz Questions

    1. History of cocaine use, ST-elevation at rest, negative cardiac enzymes, young age
    2. ST-elevation on exertion, negative cardiac enzymes, pain lasts approximately 30 min
    3. Positive cardiac enzymes, ST-depression on exertion, history of smoking
    4. History of cocaine use, positive cardiac enzymes, ST-elevation, young age
    5. ST-elevation at rest, positive cardiac enzymes, pain lasts approximately 30 min
    1. Metoprolol
    2. Diltiazem
    3. Enalapril
    4. Spirinolactone
    5. Furosemide
    1. Induction of vasospasm during angiography.
    2. Narrowing of arteries evidenced by echocardiography.
    3. ST-elevation on EKG.
    4. Symptom resolution with nitrate administration.
    5. Positive troponin I.
    1. Calcium channel blockers and nitrates.
    2. Aspirin and beta blockers.
    3. Calcium channel blockers and beta blockers.
    4. Nitrates and ACE inhibitors.
    5. ACE inhibitors and statins.
    1. Rho kinase inhibitor.
    2. Alpha-adrenergic blockade.
    3. COX-2 inhibitors.
    4. Loop diuretics.
    5. Isosorbide mononitrate.

    Author of lecture Vasospastic Angina

     Carlo Raj, MD

    Carlo Raj, MD

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