Title: The CardioNerds Five – Coronary Vasospasm

Description of Infographic

This infographic dives into key aspects of coronary vasospasm, including its pathogenesis, treatment, and related cardiac conditions. It addresses five essential questions to help clinicians and learners understand this phenomenon and its broader clinical implications:

1. What is the pathogenesis of coronary vasospasm?
   • In coronary vasospasm, the vascular smooth muscle layer constricts, reducing blood flow and potentially causing myocardial ischemia. This can be triggered by emotional stress, cocaine, cigarette smoking, or cold exposure. While the underlying mechanisms remain poorly understood, sympathetic tone imbalance, chronic inflammation, and hypercontractility play a role.
2. What is the treatment for coronary vasospasm?
   • Avoiding triggers, especially smoking, is crucial. Medications like non-selective beta-blockers and triptans should also be avoided as they can worsen vasospasm. Long-acting calcium channel blockers and long-acting nitrates are recommended for managing recurrent episodes and preventing attacks.
3. What are the etiologies of ischemic mitral regurgitation (IMR)?
   • IMR may arise from primary causes (e.g., papillary muscle rupture) or secondary causes (e.g., regional or global left ventricular dysfunction from ischemia). Ventricular remodeling can restrict leaflet motion, impair coaptation, and lead to annular dilation, culminating in mitral regurgitation.
4. What are the non-cardiac causes of STE on EKG?
   • Conditions like raised intracranial pressure (ICP), hyperkalemia, pulmonary embolism, and pneumonia can mimic acute MI by producing ST-segment elevation (STE). Non-ACS cardiac causes include pericarditis, Brugada syndrome, stress cardiomyopathy, and post-cardioversion changes.
5. What are the cardiac manifestations of hemochromatosis?
   • Cardiac hemochromatosis results from excessive iron deposition, causing diastolic dysfunction and arrhythmias. In advanced stages, it can lead to dilated cardiomyopathy. Cardiac MRI with T2* relaxation time measurement is the diagnostic gold standard to quantify iron overload.

Check out episode 75. Case Report: Coronary Vasospasm Presenting as STEMI – UCSF which features a case of coronary vascospasm.

Author

Dr. Karan Desai

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