Skip to main content

Acute Coronary Syndrome: Coronary Vasospasm, Emergency Medicine

Reviewed 06/2017



  • Spontaneous episodes of chest pain due to coronary artery vasospasm in the absence of increase in myocardial oxygen demand in either normal or diseased coronary vessels

  • Also known as ...


Signs and Symptoms

  • Chest pain:

    • Retrosternal

    • Radiates to neck, jaw, left shoulder, or arm

    • Occurs at rest

    • Occurs more frequently at night or in the morning

  • Palpitations

  • Presyncope or syncope

  • Associate...



Treat as any other acute coronary syndrome. 

Initial Stabilization/Therapy

  • IV access

  • Oxygen

  • Cardiac monitoring

  • Vital signs and oxygen saturation

Ed Treatment/Procedures

  • All patients wit...



Admission Criteria

  • New-onset chest pain

  • Rule-in with positive biochemical markers or provocative testing

  • Rule-in with positive biochemical markers or stress testing

  • Many patients prev...

Pearls and Pitfalls

  • 95% survival at 5 yr

  • Typical patient will have no traditional coronary risk factors other than smoking.

  • Calcium-channel blockers are 1st-line therapy.

  • 30–40% of patients are refractor...

Additional Reading

  • Crea  F, Lanza  GA. New light on a forgotten disease: vasospastic angina. J Am Coll Cardiol.  2011;58(12):1238–1240.

  • Krim  NR, Narasimhan  S, Monrad  ES. Severe multivessel coro...



  • 411.1 Intermediate coronary syndrome

  • 413.1 Prinzmetal angina


  • I20.1 Angina pectoris with documented spasm

  • I24.9 Acute ischemic heart disease, unspecified


  • 87343002 Prinzmetal angina (di...

Subscribe to Access Full Content

Sign Up for a 10-Day Free Trial

Sign up for a 10-day FREE Trial now and receive full access to all content.