A coronary artery spasm is a sudden tightening of the muscles within the arteries of your heart. When this occurs, your arteries narrow and prevent blood from flowing to your heart.

Coronary artery spasms are brief and temporary. However, they can potentially lead to further heart complications, such as a heart attack. You’re more likely to have these spasms if you have conditions that can affect the heart, such as high cholesterol or high blood pressure.

Coronary artery spasms are also known as coronary artery contractions.

Many coronary artery spasms go undiagnosed because they don’t always cause noticeable symptoms. This can be dangerous because the contractions may eventually cause a heart attack.

You may notice occasional light chest pain. It’s also possible you’re able to detect other symptoms of a coronary artery spasm. Common symptoms can include:

  • chest pain or angina
  • pain on the left side of your chest
  • chest tightness
  • a feeling of constriction

You may even experience pain that spreads from your chest to your arms, neck, or jawbone.

You may suspect coronary artery spasms if you have chest pain that:

  • occurs during rest
  • lasts from five minutes to as long as 30 minutes at a time
  • occurs most often at night or early in the morning

Researchers don’t know exactly what causes a coronary artery spasm. There are several possible contributing factors.

Autonomic nervous system. This is the body system that controls involuntary processes like heart rate and blood pressure. Researchers think this system plays a role, since coronary artery spasm often happens at night and can be activated by the neurotransmitter acetylcholine and the hormone catecholamine.

However, how these elements work together is complicated and not fully understood.

Endothelial cells. These are inside the heart. In some people with coronary artery spasm, the cells do not release enough nitric oxide. This may lead to spasm.

Oxidative stress. This can cause inflammation, damage to endothelial cells, and vascular walls to get smaller. Smoking is one cause of oxidative stress.

Smooth muscle function. The heart is made up of smooth muscle. Differences in how this muscle functions may lead to coronary artery spasm.

Genetics. There is no genetic test for coronary artery spasm. However, some people with the condition have a genetic difference that leads to the condition. For example, some people have a gene difference that affects how the endothelial cells release nitric oxide.

Inflammation, as indicated by a high-sensitivity C-reactive protein test, and insulin resistance are also associated with coronary artery vasospasm, although these may not directly cause the condition.

You have an increased risk of getting coronary artery spasms if you also have an increased risk of developing heart disease. High cholesterol and high blood pressure can directly increase your risk of arterial constriction. Other activities that put you at increased risk of coronary artery spasms include:

  • smoking
  • excess use of stimulants, such as cocaine and amphetamines
  • extreme stress
  • extreme cold
  • alcohol withdrawal

You should take steps to minimize such risk factors if you have a history of coronary artery spasms. Exposure to these triggers can increase your risk of future spasms.

A coronary artery spasm indicates that there’s a potential problem in your heart. For this reason, your doctor will likely order a variety of imaging tests. These tests can provide a clearer picture of your heart and help your doctor put together a treatment plan. The following diagnostic imaging tests may be used:

  • electrocardiogram (EKG), which is a test used to measure the electrical activity of your heart
  • echocardiogram, which is an ultrasound test that uses sound waves to create pictures of your heart
  • coronary angiography: a procedure that involves inserting a small tube (catheter) in an artery (arm or groin) threaded towards the heart, injecting a dye, and taking multiple x-ray images

There are many heart conditions. These tests are helpful because they can give your doctor the details that they need to make an accurate diagnosis. Once your doctor determines the problem with your heart, they can recommend an appropriate treatment plan.

Treatment for a coronary artery spasm focuses on relieving chest pain. This mainly involves prescription medications, such as the following:

  • Nitrates can help dilate your arteries and relax artery walls. A nitrate may be used as a long-term medication or as a pill to have on hand if you have another spasm.
  • Calcium channel blockers can reduce chest tightness by relaxing the muscles in your arteries. This medication may be taken on a long-term basis.

Your doctor may also want you to take medications that reduce high cholesterol or high blood pressure. Taking such medications can help prevent another coronary artery spasm or heart attack.

During treatment, you should eat a low-fat, low-sodium diet. You should also quit smoking if you smoke. These lifestyle changes can further reduce your chances of getting more coronary artery spasms.

Coronary artery spasms are temporary and brief, but they can have lasting consequences. When they’re left untreated, coronary artery spasms may happen more frequently and lead to:

  • heart arrhythmias, which occur when your heart beats irregularly or too fast or too slow
  • heart attacks, which occur when there’s a complete blockage of blood flow to your heart
  • cardiac arrest, which occurs when your heart stops beating suddenly because blood stops flowing to your brain
  • death

Coronary artery spasms are usually considered chronic, or long-term, conditions. This means that the condition will continue to occur and won’t go away on its own. However, the outlook is generally good if you follow your treatment plan and avoid triggers.

You can lower your risk of coronary artery spasms by preventing atherosclerosis. This involves eating a low-fat diet, exercising regularly, controlling blood pressure, and quitting smoking.

You can also reduce your chances of having coronary artery spasms by avoiding certain triggers, such as high-stress situations. Always follow your doctor’s orders to help prevent further complications.