Coronary Artery Vasospasm Differential Diagnoses

Updated: Nov 14, 2018
  • Author: Stanley S Wang, JD, MD, MPH; Chief Editor: Eric H Yang, MD  more...
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Diagnostic Considerations

Coronary artery vasospasm is an important cause of chest pain but not the exclusive cause. Atherosclerotic coronary disease is much more common, and its presence confers a worse prognosis, regardless of the cause of symptoms. Therefore, appropriate evaluation and interventions for both diseases should be considered in most of these patients.

Technical limitations of both noninvasive and invasive coronary evaluations may lead to misleading results. For example, a coronary event caused by rupture of a nonobstructive atherosclerotic plaque with thrombosis, followed by spontaneous reperfusion, may lead to a seemingly normal or innocuous coronary evaluation. In this situation, a diagnosis of vasospastic angina may be incorrectly applied, and important interventions to treat and prevent further atherosclerotic events may be delayed.

A full reevaluation of the clinical syndrome should follow an unexpected angiographic or other diagnostic result.

Differential Diagnoses