Abstract
The review discusses an analysis of the literature on various aspects of the pathogenesis, diagnosis and treatment of vasospastic angina (VA). Data on the prevalence of coronary artery spasm (CAS) in various populations, as well as risk factors and triggers, are presented. We considered pathophysiological mechanisms of CAS, including hyperreactivity of coronary smooth muscle cells, endothelial dysfunction, nonspecific inflammation, oxidative stress, magnesium deficiency, autonomic imbalance, etc. The relationship of CAS with coronary atherosclerosis and thrombosis is emphasized. Modern recommendations for the diagnosis and treatment of VA are presented. Invasive verification of CAS is performed by pharmacological provocation tests with certain contraindications. Calcium antagonists and their combination with long-acting nitrates play a key role in the treatment of VA. Medications with a prospect for use in VA are Rho-kinase inhibitors, ATP-sensitive potassium channel activators, alpha-1 blockers. The management of patients with refractory VA and the prospects for endovascular treatment are discussed. It was noted that patients with multi-vessel VA are more likely to develop life-threatening arrhythmias and sudden death.
Highlights
The review discusses an analysis of the literature on various aspects of the pathogenesis, diagnosis and treatment of vasospastic angina (VA)
We considered pathophysiological mechanisms of coronary artery spasm (CAS), including hyperreactivity of coronary smooth muscle cells, endothelial dysfunction, nonspecific inflammation, oxidative stress, magnesium deficiency, autonomic imbalance, etc
Invasive verification of CAS is performed by pharmacological provocation tests with certain contraindications
Summary
И. — д.м.н., профессор, член-корреспондент РАН, директор департамента клинической медицины школы биомедицины, ORCID: 0000-0002-9250-557X, Циванюк М. М.н., профессор департамента клинической медицины школы биомедицины, ORCID: 0000-0001-5830-1322, Карпов Р. АХ — ацетилхолин, БКК — блокатор кальциевых каналов, ВС — вазоспастическая стенокардия, ГМК — гладкомышечная клетка, ИБС — ишемическая болезнь сердца, ИМ — инфаркт миокарда, КА — коронарная артерия, КАГ — коронароангиография, ЛЦМ — легкая цепь миозина, ОКС — острый коронарный синдром, СКА — спазм коронарной артерии, ФЛЦМ — фосфатаза легкой цепи миозина, ФР — факторы риска, ЭД — эндотелиальная дисфункция, ЭКГ — электрокардиограмма, ALDH2 — альдегиддегидрогеназа 2, L-NMMA — L-монометил-аргинин, NO — оксид азота, ROCK — Rho-киназа.
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