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unstable angina; after percutaneous transluminal coronary angioplasty (PTCA) after cardiac surgery 'neurogenic' stunned myocardium following an acute cerebrovascular event such as a subarachnoid hemorrhage; in patients undergoing chronic hemodialysis, chronic myocardial stunning may lead to heart failure
Coronary vasospasm refers to when a coronary artery suddenly undergoes either complete or sub-total temporary occlusion. [1]In 1959, Prinzmetal et al. described a type of chest pain resulting from coronary vasospasm, referring to it as a variant form of classical angina pectoris. [2]
Unstable angina is a type of angina pectoris [1] that is irregular or more easily provoked. [2] It is classified as a type of acute coronary syndrome. [3] It can be difficult to distinguish unstable angina from non-ST elevation (non-Q wave) myocardial infarction.
The primary factor differentiating unstable angina from stable angina (other than symptoms) is the underlying pathophysiology of the atherosclerosis. The pathophysiology of unstable angina is the reduction of coronary blood flow due to transient platelet aggregation on apparently normal endothelium, coronary artery spasms, or coronary thrombosis.
Variant angina is caused by vasospasm, a narrowing of the coronary arteries due to contraction of the heart's smooth muscle tissue in the vessel walls. [3] In comparison, stable angina is caused by the permanent occlusion of these vessels by atherosclerosis, which is the buildup of fatty plaque and hardening of the arteries. [4]
Coronary angioplasty is indicated for coronary artery diseases such as unstable angina, NSTEMI, STEMI and spontaneous coronary artery perforation. [1] PCI for stable coronary disease has been shown to significantly relieve symptoms such as angina, or chest pain, thereby improving functional limitations and quality of life. [4]
Reperfusion therapy is a medical treatment to restore blood flow, either through or around, blocked arteries, typically after a heart attack (myocardial infarction (MI)). Reperfusion therapy includes drugs and surgery. The drugs are thrombolytics and fibrinolytics used in a process called thrombolysis.
In unstable angina, symptoms may appear on rest or on minimal exertion. [6] The symptoms can last longer than those in stable angina, can be resistant to rest or medicine, and can get worse over time. [8] [10] Though ACS is usually associated with coronary thrombosis, it can also be associated with cocaine use. [11]