Coronary spasm refers to the clinical syndrome of coronary artery transient contraction caused by various reasons, which causes incomplete or complete occlusion of blood vessels, leading to myocardial ischemia, angina pectoris, arrhythmia, myocardial infarction and sudden death.It has important clinical significance in the diagnosis, treatment and prognosis of myocardial ischemic disease.Frequent attacks, severe symptoms, accompanied by arrhythmia, atrioventricular block, heart failure.
TCM disease name
Coronary spasm
Foreign name
Coronaryspasm
Visiting department
Cardiovascular Department
Common diseases
Coronary artery of heart
common symptom
Angina pectoris, arrhythmia, myocardial infarction and sudden death
atlas
Science popularization in China
Committed to authoritative science communication
The certification expert of this term is
Chen Ling|Deputy chief physician
Department of Cardiology, Affiliated Hospital of Shaanxi University of Traditional Chinese Medicineto examine
Angina pectoris, arrhythmia, myocardial infarction and sudden death
Etiology and common diseases
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1. Variant angina pectoris
Coronary angiography confirmed that the main cause of variant angina pectoris was coronary spasm.Variant angina can be divided into two types: one is based on coronary atherosclerosis, and the other is normal coronary artery.
2. Exertional angina
That is, angina pectoris during exercise.Coronary artery spasm also exists in this type of attack confirmed by coronary angiography.During labor, the myocardial oxygen consumption increases, and the supply and demand of myocardial oxygen is unbalanced. Vasospasm further aggravates myocardial ischemia, causing angina pectoris.
3. Unstable angina pectoris
The onset of this type of angina is related to the rapid progress of atherosclerosis.But there are also coronary artery spasm factors.Patients with normal coronary artery can also suffer from unstable condition due to repeated spasm.
4. Acute myocardial infarction
Coronary atherosclerosis is prone to vasospasm, which makes the lumen from partially blocked to completely blocked, thus causing myocardial infarction.Myocardial infarction is caused by continuous myocardial ischemia due to continuous spasm of normal coronary artery.In addition, continuous coronary spasm can cause blood stasis and vascular intima damage, promote platelet aggregation and plaque formation, and finally form thrombus and myocardial infarction.
5. Sudden death
Both normal coronary artery and coronary atherosclerotic stenosis can cause sudden death due to coronary artery spasm.Its mechanism is fatal arrhythmia, such as ventricular fibrillation, severe atrioventricular block, ventricular arrest, etc.
6. Other common diseases
(1) Diabetic heart disease in the elderly.
(2) Stable angina pectoris.
(3) Alcoholic cardiomyopathy.
(4) Unstable angina pectoris in the elderly.
(5) Asymptomatic myocardial ischemia.
inspect
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1. ECG examination
The coronary artery spasm cannot be ruled out in normal persons.Electrocardiogram can not accurately locate, nor can it understand the degree of coronary artery spasm.
2. Coronary angiography
Coronary angiography has definite diagnostic value for coronary spasm.The diagnosis can be confirmed if the following conditions are met: ① transient stenosis or complete occlusion of normal coronary artery, or transient further stenosis or complete occlusion of coronary atherosclerotic stenosis. ②Nitrates, calcium antagonists and other crown expanding drugs make the above-mentioned stenosis or occlusion disappear rapidly or spontaneously.
3. Excitation test
(1) Cold pressure testThat is, by reflex stimulating the sympathetic nerve, coronary artery contraction is induced.Immerse both hands in 4 ℃ cold water to reach the wrist joint, take it out one minute later, and then observe the clinical symptoms and ECG changes at 1 minute, 2 minutes, 5 minutes, 10 minutes, and 20 minutes.It is positive if it conforms to either ST segment elevation or typical myocardial ischemia in ECG.This method is simple and easy, but its sensitivity is low.
(2) Ergometrine testDuring coronary angiography, ergometrine is injected into muscle or coronary artery to stimulate coronary artery spasm.This method has high sensitivity and specificity.But sometimes serious arrhythmia, myocardial infarction and sudden death may occur.It needs to be carried out under the condition that cardiopulmonary resuscitation is fully prepared.
4. Cardiac radionuclide examination
Thallium myocardial perfusion angiography can be used to observe the lack of radionuclide perfusion in the corresponding ischemic area when coronary artery spasm occurs. After the spasm is relieved, myocardial perfusion can be improved.
differential diagnosis
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1. Acute pericarditis
In particular, acute nonspecific pericarditis can cause severe and lasting precordial pain.However, patients with pericarditis have fever and increased white blood cell count at the same time or before the pain. The pain is often aggravated when deep breathing and coughing. Physical examination can find pericardial friction sound, and the condition is generally not as serious as myocardial infarction.
2. Acute pulmonary embolism
Massive pulmonary embolism can often cause chest pain, dyspnea, hemoptysis and shock, but there is a sharp increase in the right heart load.Such as rapid enlargement of the right ventricle and hyperechoia of the second heart sound in the pulmonary valve area.
3. Acute abdomen
Patients with acute pancreatitis, peptic ulcer perforation, acute cholecystitis, and cholelithiasis may have upper abdominal pain and shock, which may be confused with patients with acute myocardial infarction whose pain affects the upper abdomen.However, it is not difficult to make a differentiation after careful inquiry of medical history and physical examination.
4. Separation of aortic dissection
It starts with severe chest pain, rather like acute myocardial infarction.But the pain peaked at the beginning, often radiating to the back, ribs, abdomen, waist and lower limbs. The blood pressure and pulse of the two upper limbs can be significantly different. A few have aortic valve insufficiency, and some may have temporary paralysis or hemiplegia of the lower limbs.
Therapeutic principles
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1. Nitroglycerin is contained in sublingual mouth, which can be repeated for those who do not feel relieved (pay attention to blood pressure).Drugs such as diltiazem can also be used.Avoid using vasoconstrictors and beta blockers.
2. In case of severe hypotension, dopamine should be used at the same time to maintain blood pressure.In case of cardiac arrest, cardiopulmonary cerebral resuscitation should be started immediately.
