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Heart Spasm

What is a heart spasm?

In some people, the heart vessels suddenly contract. Because of this, a stenosis develops. This stenosis blocks blood flow and the heart tissue does not get enough oxygen after the stenosis. The result is sudden pain in the chest. This problem is called heart spasm is called Normally, darteries have the ability to dilate when needed to increase blood flow and to return to their original state when the need for blood flow is over. This is achieved by the muscle cells in the vessel walls. These cells lengthen and shorten, allowing the diameter of the vessel to change. However, in some people, due to chemicals in the blood that bind to these cells and stimulate them, these cells contract unnecessarily and the vessel contracts, resulting in temporary stenosis. In medical language, "spasm" means "contraction". Sometimes the spasm is caused by stress, sometimes by anxiety, sometimes by a trigger such as taking stimulant medication, and sometimes it happens spontaneously, especially in the early morning hours. In this case, the patient presents to the emergency room with sudden onset of chest pain, similar to a heart attack.

How is heart spasm diagnosed?

ECG is very important in the diagnosis. When the patient has chest pain, the ECG shows signs of vascular stenosis, but when the chest pain resolves spontaneously or with medication, the ECG returns to normal. However, it is still urgent angioplasty with classic heart attackof it must be proved that this is not the case. DThe reason for the blockage of the arteryis a clot in an alpine crisis and contraction in a heart spasm. Also in heart spasm in angiography a stenosis is detected in the vessel. However, this stenosis is immediately corrected by vasodilating drugs (e.g. nitroglycerin) given directly into the heart vessel, i.e. the vessel dilates. Stenoses caused by fatty deposits or clots in the vessel wall are not affected by these drugs. With this difference, heart spasm, or more accurately vascular spasm the diagnosis is confirmed. Sometimes the patient's chest pain goes away on its own until the ECG is taken and the ECG is therefore normal. In this case, if the doctor suspects that the patient may have a heart spasm from the way the patient complains, he or she will order additional tests. For example, he may fit a 24-72 hour rhythm Holter device. This device continuously records the ECG. If chest pain occurs while the device is on the patient, it is seen that the ECG recording at that moment is also distorted and spasm is diagnosed. Rarely, until this stage diagnosis not diagnosed, but there may still be suspicion. In this case, the patient undergoes an angiogram and a vasoconstrictor (acetylcholine) is injected directly into the heart vessels. While normal vessels contract partially and slightly, the spasm-prone vessel contracts excessively. In this way, the diagnosis is confirmed. 

How is heart spasm treated?

In treatment; quitting smoking and alcohol, which are known to be triggers, Stress management and avoidance of stimulants such as excessive coffee and strong tea are very important. Stres yönetiminde kaygı giderici ilaçların kullanılması gerekebilir. Most patients also require lifelong vasodilator medication. BThese are drugs known as nitrates and calcium channel blockers. These drugs bind to and block the places (cell receptors) where the chemicals would bind. Thus, these chemicals cannot find a place to bind and therefore cannot constrict blood vessels.

References

  1. Byrne RA, Rossello X, Coughlan JJ, et al. ESC Guidelines for the management of acute coronary syndromes. Eur Heart J. 2023 Oct 12;44(38):3720-3826.
  2. Rao, S, O'Donoghue, M, Ruel, M. et al. ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the management of patients with acute coronary syndromes. JACC. 2025;85 (22):2135-2237.

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