Int J Med Sci 2020; 17(8):1071-1082. doi:10.7150/ijms.43472 This issue

Review

Myocardial Ischemic Syndromes, Heart Failure Syndromes, Electrocardiographic Abnormalities, Arrhythmic Syndromes and Angiographic Diagnosis of Coronary Artery Spasm: Literature Review

Ming-Yow Hung1,2,3✉, Nicholas G. Kounis4, Meng-Ying Lu1, Patrick Hu5,6

1. Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
2. Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan
3. Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
4. Department of Cardiology, University of Patras Medical School, Rion, Patras, Achaia, Greece
5. University of California, Riverside, Riverside, California, USA
6. Department of Cardiology, Riverside Medical Clinic, Riverside, California, USA

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Citation:
Hung MY, Kounis NG, Lu MY, Hu P. Myocardial Ischemic Syndromes, Heart Failure Syndromes, Electrocardiographic Abnormalities, Arrhythmic Syndromes and Angiographic Diagnosis of Coronary Artery Spasm: Literature Review. Int J Med Sci 2020; 17(8):1071-1082. doi:10.7150/ijms.43472. Available from https://www.medsci.org/v17p1071.htm

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Abstract

In coronary artery spasm (CAS), an excess coronary vasoconstriction causing total or subtotal vessel occlusion could lead to syncope, heart failure syndromes, arrhythmic syndromes, and myocardial ischemic syndromes including asymptomatic myocardial ischemia, stable and unstable angina, acute myocardial infarction, and sudden cardiac death. Although the clinical significance of CAS has been underrated because of the frequent absence of symptoms, affected patients appear to be at higher risk of syncope, serious arrhythmias, and sudden death than those with classic Heberden's angina pectoris. Therefore, a prompt diagnosis has important therapeutic implications, and is needed to avoid CAS-related complications. While a definitive diagnosis is based mainly on coronary angiography and provocative testing, clinical features may help guide decision-making. We perform a literature review to assess the past and current state of knowledge regarding the clinical features, electrocardiographic abnormalities and angiographic diagnosis of CAS, while a discussion of mechanisms is beyond the scope of this review.

Keywords: myocardial ischemic syndrome, heart failure syndrome, arrhythmic syndrome, provocative testing, coronary artery spasm