Table of contents

Vasospastic angina

What's new

Added 2023 JCS/CVIT/JCC, 2021 ESC, and 2014 AHA/ACC guidelines for the diagnosis and management of vasospastic angina.


Key sources

The following summarized guidelines for the evaluation and management of vasospastic angina are prepared by our editorial team based on guidelines from the Japanese College of Cardiology (JCC/CVIT/JCS 2023), the European Society of Cardiology (ESC 2021,2020), and the American Heart Association (AHA/ACC 2014). ...
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Diagnostic investigations

ECG monitoring: as per ESC 2020 guidelines, consider obtaining ambulatory ECG recording, preferably 12-lead monitoring, in patients with suspected vasospastic angina.
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  • Coronary flow reserve assessment

  • Coronary CTA

  • Cardiac MRI

  • Cardiac PET

  • Cardiac scintigraphy

  • Vascular endothelial function testing

Diagnostic procedures

Coronary angiography: as per ACC/AHA 2014 guidelines, obtain coronary angiography (invasive or noninvasive) in patients with episodic chest pain accompanied by transient ST-segment elevation to rule out severe obstructive coronary artery disease.

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  • Coronary provocative testing (general indications)

  • Intravascular ultrasound/optical coherence tomography

  • Coronary provocative testing (INOCA)

  • Coronary provocative testing (MINOCA)

  • Coronary provocative testing (post-PCI)

Medical management

CCBs: as per ESC 2021 guidelines, consider administering CCBs in patients with suspected/confirmed vasospastic angina.

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  • Nitrates

  • Beta-blockers

  • Statins

  • Aspirin

Nonpharmacologic interventions

Smoking cessation: as per CVIT/JCC/JCS 2023 guidelines, advise smoking cessation in patients with vasospastic angina.

Therapeutic procedures

Intracoronary fasudil administration: as per CVIT/JCC/JCS 2023 guidelines, consider administering intracoronary fasudil in patients with refractory coronary spasm.

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  • ICD

Surgical interventions

Stellate ganglion block and/or thoracic sympathectomy: as per CVIT/JCC/JCS 2023 guidelines, consider performing stellate ganglion block and/or thoracic sympathectomy in patients with refractory or severe vasospastic angina.

Follow-up and surveillance

Cardiac rehabilitation
As per CVIT/JCC/JCS 2023 guidelines:
Offer comprehensive cardiac rehabilitation after INOCA in the absence of contraindications.
Advise moderate-to-vigorous aerobic exercise (≥ 30 min, at least thrice weekly).