Coronary artery spasms temporarily tighten the arteries that wrap around your heart. Your coronary arteries are blood vessels that supply blood and oxygen to your entire heart muscle. The artery walls have muscles that can quickly contract during a spasm, causing less blood to reach your heart.
Not everyone has symptoms, but sometimes coronary artery spasms cause chest pain called angina. Unlike other types of angina which usually occur in a blocked artery, coronary artery spasms can happen when you're resting or in a healthy artery.
Also called vasospastic angina and Prinzmetal angina, this spasm typically goes away after 5-15 minutes or up to 30 minutes later. Depending on how long the spasm lasts, it can limit or completely block the blood flow to your heart. Find out what causes coronary artery spasms, how they're diagnosed, and treated.
What Causes Coronary Artery Spasms?
Sometimes, the cause is unknown but experts think coronary artery spasms may be caused by:
- Use of stimulants such as amphetamines or cocaine
- Alcohol use
- Medications that affect the blood vessels
- Heart procedures
- Infections (such as botulism)
- Magnesium deficiency
- Hyperventilation
- Cold weather
- Allergic reaction
- Stress (physical or mental)
- Migraines
Usually, a coronary artery spasm takes place in an artery clogged with plaque buildup, but it can also happen in arteries that do not have plaque inside them. Typically, it only happens in one part of the artery, but it can occur in more than one.
You are at a higher risk of coronary artery spasms if you:
- Smoke cigarettes
- Have high blood pressure
- Have high cholesterol
- Have insulin resistance
Cigarette smoking and stimulants can raise your risk the most. Most people with high blood pressure and high cholesterol also smoke. But if you quit smoking, you can lower your chances of coronary artery spasms. Sometimes, a spasm can occur without a known cause.
Coronary Artery Spasm Symptoms
Coronary artery spasms don't always lead to symptoms unless they're strong enough to cause chest pains. About 2% of people have chest pain with these spasms.
With coronary artery spasms, symptoms may occur:
- In the early morning or after midnight
- On the left side of your chest
- As pain that wakes you up at night
Variant angina
When your heart can't get enough blood flow, the resulting chest pain is called angina. A coronary artery spasm that causes pain can bring on a rare condition called variant angina. It's also called Prinzmetal's or Prinzmetal angina, or angina inversa.
"Coronary artery spasms tend to occur predominantly at rest and usually in the early morning," says Antonio Sotolongo, MD, a cardiologist with Piedmont Healthcare in Athens, Georgia. "Patients also tend to be younger, usually between 40 and 70 years old."
Usually, with coronary artery spasms, you may feel:
- Intense chest pain under your breast bone (sternum), on the left
- Like your chest is being squeezed
- Pain that spreads to other parts of your body, such as your neck, arm, shoulder, or jaw
Coronary artery spasms usually happen during your sleep, at the same time each day. They can last up to 30 minutes and sometimes cause you to pass out.
Chest pain is usually a sign of heart disease. So it's important to get medical treatment if you have symptoms of a variant or any other type of angina.
When to call the doctor
Coronary artery spasms can sometimes last a long time and turn into a heart attack.
Call 911 or get medical attention right away if you:
- Get lightheaded or dizzy
- Faint (have syncope)
- Have a racing heart (palpitations)
- Get nausea or indigestion
- Short of breath
- Sweat
How Are Coronary Artery Spasms Diagnosed?
After you go to the doctor and describe your symptoms, your doctor will order imaging tests.
Electrocardiogram
An electrocardiogram (EKG) can check the electrical signals of your heart. It requires no preparation and does not take very long. EKGs can detect abnormal heart patterns both during a spasm and after one.
Echocardiogram
An echocardiogram (echo) is simply an ultrasound of your heart. Your doctor will be able to map out your heartbeat using a sonic test. They will place a wand on the top of your chest that can pick up high-frequency sound waves. These sounds allow them to paint a picture of the different parts of your heart.
Coronary computed tomography angiography
Coronary computed tomography angiography (CCTA) is a procedure where your doctor injects contrast dye into a blood vessel. You'll then get a CT scan of your heart. The detailed images can show your doctor any spasms. With this type of angiography, you won't need any tubes inside your body.
Coronary angiography
Also called a coronary angiogram, this procedure may be the best way to detect if you have a coronary artery spasm. It is a type of cardiac catheterization. Narrow tubes (catheters) are inserted into your blood vessels to diagnose and treat any blockages.
Ambulatory monitor
You may need to spend 24 hours or more on an ambulatory monitor. That means you can walk around with it. You'll wear a device to record your heart rhythms as you go about your normal activities. The monitor can show your doctor your heart's patterns and possible spasms at all times of the day.
Coronary Artery Spasm Treatment
Coronary artery spasms can become life-threatening, depending on how serious the blockage is inside your arteries. You may have a higher risk for several different conditions such as:
- Heart attack (cardiac arrest)
- Organ failure
- Heart failure
- Sudden death
Thankfully, there are many treatment plans that can help keep you safe.
Talk to your doctor about the right treatment for your health. Here are some of the most common medications prescribed for coronary artery spasms:
- Nitroglycerin
- Calcium channel blockers
- Long-acting nitrates
- Beta-blockers
If your symptoms persist, your doctor may prescribe:
- Cilostazol (Pletal), along with a calcium channel blocker
- Clonidine (Catapres, Catapres-TTS), along with a calcium channel blocker
- Guanethidine (Ismelin), along with a calcium channel blocker
- Statins
Lifestyle changes to lower the risk for coronary artery spasms
In addition to medications, simple lifestyle changes can help you lower your chances of getting a coronary artery spasm.
But some medications used for migraines or chemotherapy can raise your risk of spasms. Tell your doctor about all the medications you're taking. They can help you decide what's best for your health.
"Interestingly, the risk factors for coronary spasm are similar to those of atherosclerosis," says Frank Corrigan, MD, interventional cardiologist at Wellstar Health System in Atlanta. "A healthy diet and exercise can help both conditions."
Ask your doctor about the best exercise for your heart. If possible, Corrigan suggests aiming for at least 150 minutes of moderate or 75 minutes of vigorous exercise each week. This can lower your cardiovascular risk and help you have fewer spasms.
"Key tenets of a healthy diet include eating fruits and vegetables, nuts, fiber, and whole grains," Corrigan says. "But try to keep red meats, processed foods, and sugary or artificially sweetened beverages low."
What Is the Life Expectancy for Someone With Coronary Artery Spasm?
If you're dealing with coronary artery spasms, your long-term outlook is quite good, says Corrigan. With treatment, most people do very well.
"One study suggests a five-year survival as high as 95%, though many patients continue to have symptoms," Corrigan says. "There are many medications available that can treat the symptoms and prevent spasms. If coronary spasms occur, it's important to have a cardiologist involved to guide your therapy."
But these numbers can be different for everyone. How long you live can depend on:
- Your other medical conditions
- Blockage in your arteries
- How serious your chest pain gets
- If you've had a heart attack
Talk to your doctor about your specific situation and the best treatment for your heart health.
Takeaways
Coronary artery spasms happen when the blood vessels that bring blood to your heart muscle tighten. They often happen in the morning or when you're at rest, and you might not even notice you're having them. Smoking, stress, high blood pressure, and high cholesterol can trigger them, but you can lower your risk if you eat a healthy diet, exercise regularly, and avoid smoking. Coronary artery spasms can be serious, but with treatment, your long-term outlook is good.
Coronary Artery Spasm FAQs
Are artery spasms serious?
They can be. Serious cases of coronary artery spasms can cause a heart attack or life-threatening abnormal heart rhythms. But with treatment, most people get chest discomfort that comes and goes. And in many cases, you may not even notice you're having artery spasms.
What is the survival rate for coronary artery spasm?
About 99 in 100 people who get treatment for coronary artery spasm survive for a year. And one study reported about 95 in 100 people with coronary artery spasms survive for 5 years with treatment.
But everyone responds differently to treatment. Your age, medical conditions, and other health factors can play a role in how long you'll live. Talk to your doctor about your specific situation to find out more.
How do you stop coronary artery spasms naturally?
The easiest way to lower your risk for coronary artery spasms is to make simple lifestyle changes, such as:
- Eat a healthy diet high in fruits, veggies, nuts, and fiber.
- Stop smoking.
- Exercise for at least 150 minutes each week.
- Take medications for your condition as directed.
- Lower your stress.
