title: The Who, What, Why, When, How and Where of Vasospastic Angina.
abstract: Ischemic heart disease involves both "structural" and/or "functional" disorders of the coronary circulation. Structural atherosclerotic coronary artery disease (CAD) is well recognized, with established diagnostic and treatment strategies. In contrast, "functional CAD" has received limited attention and is seldom actively pursued in the investigation of ischemic heart disease. Vasospastic angina encompasses "functional CAD" attributable to coronary artery spasm and this "state of the art" consensus statement reviews contemporary aspects of this disorder. Patients with vasospastic angina typically present with angina at rest that promptly responds to short-acting nitrates and is associated with transient ischemic ECG changes. Although spontaneous episodes may be documented, provocative spasm testing may be required to confirm the diagnosis. It is important to diagnose vasospastic angina because it may be associated with major adverse events that can be prevented with the use of appropriate vasodilator therapy (eg, calcium-channel blockers) and the avoidance of aggravating stimuli (eg, smoking). Future studies are required to clarify the underlying pathophysiology, natural history and effective treatments for patients refractory to conventional therapy.
authors.affiliation: The Queen Elizabeth Hospital Discipline of Medicine, University of Adelaide, Central Adelaide Local Health Network.
authors.forename: John F
authors.initials: JF
authors.lastname: Beltrame
authors.forename: Filippo
authors.initials: F
authors.lastname: Crea
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Kaski
authors.forename: Hisao
authors.initials: H
authors.lastname: Ogawa
authors.forename: Peter
authors.initials: P
authors.lastname: Ong
authors.forename: Udo
authors.initials: U
authors.lastname: Sechtem
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Shimokawa
authors.forename: C Noel
authors.initials: CN
authors.lastname: Bairey Merz
mesh_terms: D000789:Angina, Unstable / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D003329:Coronary Vasospasm / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D004562:Electrocardiography / Q000379:methods; D006801:Humans