Acute and Chronic Disease Reports
Open Access

Coronary Artery Spasm and its Role in Myocardial Infarction

John Smith^{* *}Correspondence: John Smith, Department of Medicine, University of California, California, USA, Email:

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Description

Coronary artery spasm, often referred to as "Prinzmetal’s angina" when it causes chest pain, is a condition that has garnered increasing attention for its role in Myocardial Infarction (MI). While atherosclerotic plaque rupture is widely known as the predominant cause of heart attacks, coronary artery spasm can lead to acute ischemia and is an important mechanism in certain types of MI, particularly when there is no significant underlying Coronary Artery Disease (CAD). Overviewing coronary artery spasm’s pathophysiology and its contribution to MI provides critical insights into both diagnosis and management, particularly in cases where the classic atherosclerotic cause may not be present. Coronary artery spasm is a temporary, reversible constriction of the coronary arteries, which reduces blood flow to the heart muscle, leading to ischemia. This spasm can occur in any coronary artery but is most commonly observed in the large epicardial arteries. Spasm can be triggered by a variety of factors, including endothelial dysfunction, stress, drugs, smoking and cold exposure. In a normally functioning coronary artery, smooth muscle relaxation and contraction are tightly regulated by nitric oxide and other vasodilators. In patients prone to spasm, however, an imbalance in these regulators-often due to endothelial damage or excessive sympathetic nervous system stimulation-can result in abnormal vasoconstriction. The role of coronary artery spasm in myocardial infarction is particularly significant when it leads to prolonged, complete occlusion of the affected artery. During this event, blood flow to the myocardium is halted, depriving the heart muscle of oxygen and causing tissue injury. If left uncorrected, this ischemic injury can progress to myocardial necrosis, or infarction, resulting in permanent damage to the heart muscle. In cases where a spasm occurs on an already narrowed artery, typically due to atherosclerotic plaque, the risk of infarction is heightened, as the spasm exacerbates the existing obstruction. The exact mechanism by which coronary artery spasm leads to myocardial infarction remains complex, but several factors contribute to its harmful effects. First, the spasm itself creates an abrupt and severe reduction in blood flow. If this occlusion is sustained for even a few minutes, it can lead to irreversible myocardial injury. The degree of injury depends on the duration of ischemia and the collateral blood flow available to the affected area of the heart. In many cases, the spasm is transient and blood flow is restored, but the damage done during the ischemic period may still result in infarction, especially if the spasm is severe. Second, spasm may be triggered by the same factors that cause plaque rupture in atherosclerosis, such as inflammatory mediators or physical stress. In patients with CAD, a spasm can occur at the site of an existing plaque, increasing the likelihood of total coronary artery occlusion and myocardial infarction. This combination of spasm and plaque rupture is particularly dangerous, as it leads to a "double insult" to the coronary circulation-first by obstructing the artery with a thrombus (blood clot) and second by exacerbating the flow limitation due to the spasm itself. Patients with myocardial infarction due to coronary artery spasm often present with symptoms similar to those seen in traditional heart attacks, such as chest pain, shortness of breath and nausea.

Conclusion

Coronary artery spasm plays a critical, though often underappreciated, role in the pathogenesis of myocardial infarction. While the classic view links heart attacks primarily to atherosclerotic plaque rupture, the role of coronary spasm-especially in patients without significant CAD-demands greater attention. This condition presents unique diagnostic and therapeutic challenges, given its often transient nature and lack of classic risk factors. Awareness of the role of coronary artery spasm in MI can lead to better patient outcomes by guiding appropriate treatment strategies that focus on preventing and managing this reversible yet dangerous condition. Overviewing its pathophysiology is important in developing a comprehensive approach to treating myocardial infarction and improving the overall prognosis for affected patients.