“How is coronary artery spasm diagnosed?”

Coronary artery spasm is a difficult problem to diagnose. It can be diagnosed by combining EKG tracing and an investigative technology called CS100 that I research. CS100 demonstrates coronary arterial blood flow.

It is often a diagnosis of exclusion, when sporadic angina is present with no coronary disease present. It also can be provoked in the cath lab, also this is not commonly done

Most of the time, a clinical diagnosis can be done in the cath lab, but is invasive.

The definitive diagnosis is made by direct observation during coronary angiography in the cath lab. Back in 1990's, it was used medicine to trigger the spams. Clinically it could mimic heart attack with typical angina associated with typical heart attack ECG changes. However, it is a transient change and ECG changes will return to normal when spams ceases. It is more often seen in cocaine use and cigarette smokers.

Coronary spasm or Prinzmetal's angina, often referred to as "variant" angina, is a temporary increase in coronary vascular tone (vasospasm) causing a marked, but transient reduction in luminal diameter. This coronary vasospastic state is usually focal at a single site and can occur in either a normal or diseased vessel. Patients are predominantly younger women who may not have the classical cardiovascular risk factors (except for cigarette use). The most sensitive and specific test for Prinzmetal's angina is the administration of ergonovine intravenously. Fifty micrograms at 5-minute intervals is given until a positive result or a maximum dose of 400 microg has been administered. When positive, the symptoms and associated ST-segment elevation should be present. The prognosis is typically good when there is no significant coronary artery stenosis.

Documented coronary artery spasm is diagnosed during a cardiac angiogram. Arteries are found to be in spasm without any plaques in them and they respond to intravascular injection of vasodilatory agents.