Читать книгу Practical Cardiovascular Medicine - Elias B. Hanna - Страница 19

It was initially hypothesized by Prinzmetal and then demonstrated in a large series that coronary vasospasm and vasospastic angina most often occur in patients with significant CAD at the site of a significant and sometimes unstable atherosclerotic obstruction.^13-15 In fact, a ruptured plaque is commonly accompanied by vasospasm, as the activated platelets and leukocytes release vasoconstrictors.

Vasospasm also frequently occurs without obstructive coronary atherosclerosis and may lead to chronic vasospastic angina. In fact, in the current era, the term “coronary vasospasm” is mainly used to identify this “isolated coronary vasospasm” with no severe CAD. Indeed, isolated vasospasm is frequently the underlying disease process in patients with typical angina or MI yet no significant CAD.^16-19 The diagnosis is definitely made when: (i) vasospasm is angiographically reproduced with provocative testing, along with (ii) symptoms and (iii) ST changes during testing.

Endothelial dysfunction, which underlies isolated coronary vasospasm, may also occur at the microvascular level and manifest as diffuse microvascular constriction, not visible angiographically, or as insufficient microvascular dilatation during stress.