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Coronary artery spasm: recognition and treatment.

Coronary artery spasm may produce angina, major arrhythmias, syncope, myocardial infarction, and death in patients with normal or nearly normal coronary arteriograms. The clinical picture in patients with symptomatic coronary artery spasm is characterized by: (1) predominant angina at rest, with little or no exertional angina; (2) changes of myocardial ischemia, especially ST segment elevation, on the electrocardiogram during pain: and (3) major arrhythmias and syncope during angina. A complete electrocardiogram during pain, or at least a Holter monitor recording, is important in establishing a diagnosis. The ergonovine maleate provocative test is a reliable method of establishing the diagnosis, but it is associated with some risks. Calcium flux antagonists are more effective than nitrates or beta blockers in the treatment of coronary spasm. Coronary bypass surgery is generally ineffective in the treatment of coronary spasm unless the spasm is superimposed on a fixed severe coronary obstruction.