A vasospasm is when one of the arteries carrying oxygen-rich blood throughout your body suddenly contracts. (The word "vaso" means vessel, and "spasm" is a sudden, involuntary muscle squeeze.) This forceful contraction narrows the artery and sharply reduces blood flow.
A vasospasm in the brain or the heart can block blood flow and raise the risk of stroke or heart attack. It can also happen in other parts of your body, including your hands. In some cases, we know what causes the muscular walls of the artery to contract. Other times, it's a mystery.
What Is a Cerebral Vasospasm?
A cerebral (brain) vasospasm can happen when blood vessels in your brain get irritated, most often after a subarachnoid hemorrhage (SAH). An SAH is a type of stroke. It's a brain bleed that's most often caused by an aneurysm — a weak place in a blood vessel that can cause a balloon-like bulge. When the aneurysm bursts, blood fills the space between the brain and the tissues that cover it.
The same kind of bleeding stroke is sometimes caused by a head injury.
Cerebral vasospasm after subarachnoid hemorrhage
SAH is the most dangerous type of stroke. About half of the people who get SAH die right away. Among those who reach the hospital, about a third die, a third survive with disability, and a third recover fully.
A cerebral vasospasm is a different but related problem. It can cut off blood flow to the injured brain, putting your life at risk again and raising the chance of another stroke.
Doctors aren't sure why SAH can lead to vasospasms. Inflammation and chemical changes in the blood vessels may play a role. Vasospasm is more common after a burst aneurysm than after a traumatic brain injury.
Some estimates show that about half of the people with an aneurysm-related SAH have a cerebral vasospasm that shows up on tests. Fewer have one serious enough to cause symptoms, cut off blood flow, or lead to more brain damage.
What Are the Signs of a Cerebral Vasospasm?
Doctors closely follow people who've had an SAH to watch for signs of worsening brain function, which could mean a cerebral vasospasm. These signs most often show up within two weeks after the SAH.
Your medical team will regularly check your level of consciousness, based on a set of tests that look at your eyes and how you respond to instructions and questions. These tests show how alert you are.
Other signs can include:
- Stiff neck
- One-sided paralysis
- Speech problems
- Confusion
- Fever
How Is a Cerebral Vasospasm Diagnosed?
In addition to watching for symptoms, your doctors use various imaging tests to diagnose cerebral vasospasm. These include:
Transcranial Doppler (TCD). A type of noninvasive ultrasound that doctors can do repeatedly to monitor you for signs of vasospasm.
Computed tomography (CT) angiography. This is an X-ray with contrast dye, injected through an IV line in your arm or hand. It can be used to look at blood vessels in your brain.
CT perfusion imaging. This test uses a CT scanner and injected dye to measure blood flow in your brain.
Electroencephalogram (EEG). This test measures electrical activity in your brain and can be used to monitor brain changes after an SAH.
Sometimes, doctors use more invasive tests, which may include placing probes in your brain, to monitor brain oxygen levels and other key parameters. They may also use MRI to see how much brain tissue has been damaged by a vasospasm.
What's the Treatment for Cerebral Vasospasm?
Most cerebral vasospasms happen after an SAH. In that case, your doctor first focuses on stopping the bleeding to help protect your brain.
Treatment for vasospasm depends on the reason behind the SAH:
If you had an aneurysm. Your doctor may seal the aneurysm with a less invasive endovascular treatment. This involves threading a coil or tube through an artery to reach the aneurysm and stop the bleeding. After that, your doctors check for vasospasms and may give you medicine to keep blood flowing and prevent another stroke.
If you had a head injury. Treatment focuses on relieving pressure and reducing swelling in your brain. Your doctors may give younimodipine, a calcium channel blocker that helps protect your brain from vasospasm and other complications. They may also take steps to balance fluids and raise your blood pressure to protect your brain.
If your doctor finds a vasospasm, they may try endovascular treatment (drugs delivered right into your blood vessels through a catheter to widen them).
Another option is cerebral angioplasty, a procedure where your surgeon inserts a small tube or balloon to open the narrowed vessel. Some newer treatments are still being studied.
What Is Coronary Artery Vasospasm?
You can also have a vasospasm in an artery that supplies blood to your heart. When one of these arteries suddenly narrows and stays that way, your body reacts immediately. You might feel pain in your jaw, chest, arm, and back, feeling much like a heart attack. The episode can last from 5 to 30 minutes.
It can happen if you have no other heart disease or if you have coronary artery disease, a buildup of plaque in your arteries.
It can be dangerous either way because it can sometimes cause a heart attack or disrupt heart rhythms in a way that stops the heart, says Michael Savage, MD, a professor of cardiology at Thomas Jefferson University in Philadelphia.
A vasospasm happens when something disrupts the normal functioning of the arteries supplying blood to your heart. Sometimes, your lifestyle or medications can trigger a spasm. Causes and risk factors include:
- Smoking
- Stress or anxiety
- Exposure to cold
- Low blood levels of magnesium
- Hyperventilation
- Some legal drugs, such as medications for migraine
- Illegal drugs, such as cocaine and amphetamines
- Some herbal supplements, such as bitter orange
Combining risky behaviors, such as smoking and using cocaine, can make vasospasms more likely.
Variant angina
The pain from a coronary artery vasospasm is sometimes called variant angina. It's also called Prinzmetal angina. It happens because of reduced blood flow to your heart.
It can feel like classic angina pectoris, the chest pain and pressure caused by coronary artery plaque buildup. But there are differences.
"Classic angina usually is brought on with physical stress," when you're active, Savage says. Variant angina occurs when you're resting, most often at night. "Often, it wakes people up," he says.
Diagnosis of Coronary Artery Vasospasm
Doctors often find it hard to tell coronary artery vasospasm from other forms of heart disease. They try to rule out other heart conditions that could cause the symptoms.
"One useful diagnostic tool, if one happens to be in a medical setting when the patient is having their episode of chest pain, is to do an electrocardiogram," Savage says. This is a simple test to check electrical activity in the heart. It can pick up differences between an episode caused by vasospasm and one caused by blockages.
Doctors sometimes use angiography to look at the arteries. If you have had a heart attack, the doctor may see a blocked artery. If you have artery plaque, they may see a partially closed artery. But if you have vasospasm, the arteries can look completely clear between spasms.
For that reason, doctors sometimes use medications to see if they can trigger a spasm during the test and then safely stop it. But some cardiologists aren't trained in these procedures or are uncomfortable using them.
Diagnosis is more difficult when a person with plaque buildup from coronary artery disease has an attack that could be vasospasm.
Treatment of Coronary Artery Vasospasm
Immediate treatment of coronary artery vasospasm involves using a medication called nitroglycerin to open up the artery. To prevent future attacks, doctors most often prescribe drugs called calcium channel blockers to relax the arteries. You might get timed-release nitroglycerin to take at bedtime, as many attacks occur at night.
Doctors are looking for better treatments for the estimated 20% of people with coronary artery spasms who don't respond to standard treatments. One strategy is to use more than one calcium channel blocker at a time. We need more research to see if that works.
Some alternative drug therapies have shown limited or varying promise in studies. They haven't produced solid enough results to be widely recommended. These include statins, aspirin, magnesium, and vitamins C and E. Beta-blockers, used in some other heart conditions, aren't recommended because they may make coronary artery spasms worse.
Doctors sometimes try placing stents in affected arteries to keep them open. But that often doesn't work well, because the spasms can keep showing up in other arteries.
Vasospasm and Raynaud's Syndrome
Vasospasms of the heart and brain happen in large arteries. But the term vasospasm is also used for a syndrome in which smaller arteries constrict, also called Raynaud's syndrome. This condition causes abnormal sensations and color changes, most often in your fingers and toes. These changes usually occur in response to cold.
Your fingers or toes may turn white, blue, or red. They may burn, prickle, or feel cold. You might also get symptoms on your nose, lips, or earlobes. Cold air or water are the usual triggers, but emotional stress may be a trigger as well.
Raynaud's syndrome is most common in women aged 15 to 40. You may get it in combination with another condition, such as rheumatoid arthritis, lupus, or scleroderma. More often, the syndrome shows up on its own.
Doctors usually diagnose Raynaud's syndrome based on what you tell them about your symptoms. They also might ask you to bring in pictures of your skin changes. They'll do a physical exam and might give you some tests to see if you have another condition linked to the syndrome.
If you have Raynaud's syndrome, avoid getting too cold. In cold weather, always wear coats, hats, and mittens. You may need mittens when taking food out of the freezer. You should also avoid nicotine, which constricts blood vessels. In some cases, you might get medications. In serious cases, your doctor might suggest a procedure to block or cut tiny nerves near the affected blood vessels.
Takeaways
A vasospasm is a sudden tightening of an artery. It can reduce blood flow to your brain, heart, or other parts of your body. When it happens in your brain or heart arteries, it can cause serious problems like a heart attack or brain damage. Vasospasms can be treated with medications and other methods.
FAQs About Vasospasms
Is coronary vasospasm dangerous?
Coronary vasospasms can be dangerous, especially if they go undiagnosed or untreated. A coronary vasospasm happens when a coronary artery (a blood vessel that supplies your heart) suddenly narrows. This can reduce blood flow to the heart and cause chest pain. In more serious cases, it can lead to a heart attack. These spasms can also trigger abnormal heart rhythms, which may result in cardiac arrest or even death.
Can lifestyle or medications trigger vasospasms?
Lifestyle choices and certain medications can trigger vasospasms. Smoking, exposure to cold, emotional stress, and stimulant drugs such as cocaine or amphetamines can cause the arteries to tighten suddenly, which reduces blood flow. Some medications, including migraine treatments and decongestants that constrict blood vessels, can also lead to vasospasms.
