Coronary vasospasm: a case report and review of the literature.
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Coronary vasospasm is defined as a transient abnormal contraction of an epicardial coronary artery that results in myocardial ischemia. Vasospasm frequently occurs at the site of coronary atheroma, implicating endothelial dysfunction in the pathogenesis of this phenomenon. Definitive diagnosis is made after angiographic evidence of coronary vasoconstriction that reverses with the administration of intravenous or intra-arterial nitroglycerin. Medical therapy involves the use of high-dose calcium channel blockers and/or nitrates. In selected cases, coronary revascularization with stenting may successfully prevent the recurrence of clinically significant vasospasm but should be offered in conjunction with traditional medical therapy. Long-term prognosis of treated patients is excellent but is dependent on the severity of vasospastic episodes and the degree of underlying coronary artery disease and left ventricular dysfunction. A case of severe vasospasm that localized to the proximal left anterior descending artery and was successfully treated with stenting and vasodilator therapy is reported. The pathophysiology, diagnosis and management of coronary vasospasm are also reviewed.
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