The muscle walls of your arteries contract and expand regularly to help control blood flow. But in vasospasm, the muscles tighten for longer than normal. This reduces blood flow and sends less oxygen to your tissues.
Vasospastic disorders include Raynaud’s syndrome and coronary artery vasospasm. Treatments may include drugs to relax and widen your blood vessels. These include calcium channel blockers and nitroglycerin, which is taken at bedtime.
Symptoms
The symptoms of vasospasm depend on the type of vasospasm and the area of the body affected. In the heart and brain, the symptoms are very serious and can put your life at risk. Vasospasm reduces blood flow to the brain and the heart, so it can cause damage or death of tissue that relies on it for oxygen and nutrients.
Cerebral vasospasm can be triggered by many things, including a stroke or a hemorrhage inside the skull (subarachnoid hemorrhage). It can also be a symptom of a ruptured brain aneurysm. If you experience cerebral vasospasm, call your doctor right away.
In the legs and feet, a condition called Raynaud syndrome causes the small arteries in the fingers, toes, and nose to spasm in response to cold or stress. This can lead to the skin discoloration and numbness of the extremities. Raynaud’s phenomenon can be caused by a number of conditions, including scleroderma and other connective tissue diseases.
People with variant angina can have episodes of chest pain that occur at rest, often at night or in the early morning. They may feel a crushing, pressure-like feeling that radiates into the jaw or arm. This chest pain is different from angina caused by coronary artery disease because it doesn’t occur with exercise and is relieved by nitroglycerin.
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Other signs of vascular spasm include headache, weakness, or changes in the way your hands and feet look. Some people with Raynaud’s have a dry mouth or sore throat. They might have trouble remembering or understanding what they’ve just said. The symptoms of cerebral vasospasm are very serious, especially if they’re followed by a stroke.
Doctors diagnose vasospasm based on your medical history and a physical examination. They might test your temperature and blood pressure. They might also use imaging tests that can visualize the blood vessels, such as angiography. In this test, dye is injected into the artery and then seen with an X-ray. These tests can help doctors identify the arteries involved in vasospasm. They can also help them understand how severe your symptoms are and whether they’re getting better or worse.
Diagnosis
During vasospasm, your blood vessels become narrow or constrict. The symptoms may be severe and last for a few minutes to several hours. They may be accompanied by pain or numbness. If the spasms are in the brain, they may cause seizures or loss of consciousness. The condition can be fatal. Cerebral vasospasm is usually triggered by a serious event, such as a ruptured aneurysm or surgery.
A physical exam and a review of your symptoms are the first steps in diagnosing vasospasm. Your doctor will ask about the frequency, severity, and length of your symptoms. He or she will also look for other conditions that may have caused them, such as atherosclerosis, coronary artery disease, and a clot.
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The term vasospasm is most often used to describe constrictions of large arteries, such as in the heart and brain. But it can also refer to a syndrome that affects smaller arteries, called Raynaud’s phenomenon. This is more common in women and tends to occur after exposure to cold temperatures. It may also be a side effect of some medications, such as calcium channel blockers.
If the artery in your heart gets narrowed during vasospasm, you may experience a type of chest pain called variant angina. The pain feels like classic angina pectoris, but it happens at rest and most often at night. Your doctor can diagnose this by doing an echocardiogram or angiogram — an X-ray of your heart’s arteries taken while injecting a drug called acetylcholine. The drug should make your blood vessels relax, but if it doesn’t work, your doctor can diagnose coronary artery vasospasm.
Your doctor will prescribe drugs that promote dilation of your blood vessels to prevent and treat vasospasm. You can take nitroglycerin pills, which are available over-the-counter, or you can talk to your doctor about a more powerful prescription medication. Your doctor will also advise you to change your habits, such as wearing gloves when working in cold weather and avoiding tools that vibrate your hands.
Vasospasm is most dangerous when it occurs in the brain or the heart. To prevent this, your doctor will recommend a diet high in fiber and vitamins, and avoid smoking and excessive alcohol use. He or she will also give you medicines, such as calcium channel blockers (Verapamil, Amlodipine or Diltiazem), to stop calcium from being absorbed into the muscle cells of your blood vessels.
Treatment
The treatments for vasospastic disease vary according to where the spasms occur in your body. Those who have vasospasm in their extremities can be treated with medications that relax blood vessels. These include calcium channel blockers (such as verapamil, amlodipine and diltiazem) and beta-receptor antagonists (often called b-blockers). These drugs work by stopping calcium being absorbed into the muscle cells in your blood vessels. They also decrease your heart rate and reduce the stress put on the walls of your arteries. If you have vasospasm in your coronary arteries, treatment may also include nitroglycerin and a clot-dissolving drug such as heparin.
If you have cerebral vasospasm, treatment is very different. This is a reaction to the narrowing of your intradural blood vessels that occurs in the days after a subarachnoid hemorrhage (SAH). It’s a major cause of deterioration and death in 30% of people who have an SAH. Cerebral vasospasm is caused by the contraction of blood vessels and is triggered by breakdown products of your red blood cells that are released into the cerebrospinal fluid.
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You can help prevent vasospasm by avoiding cold temperatures and vibration, and treating any underlying health conditions that you have, such as high blood pressure or autoimmune disorders. You should also avoid smoking or taking recreational drugs and eat a well-balanced diet. You can also try exercises to improve your circulation and use techniques to manage stress. If your condition is a chronic condition, you will need to be monitored by your GP or specialist nurse. If your episodes are acute, you might need to be admitted to hospital.
If you have a vasospastic disease affecting your limbs, treatment may involve wearing compression stockings. In severe cases, your doctor might suggest denervation of your affected limbs using radiofrequency or other methods. This stops the signals from your nerves reaching the affected blood vessels and stops the spasms. This can also reduce the amount of pain you feel when you have a spasm. This treatment is invasive and can leave your limbs feeling sore, but to many people it is worth the trade-off.
Prevention
In most cases, avoiding the triggers of vasospasm is the best way to prevent the spasm from occurring. With Raynaud’s disease, for example, the simple act of preventing exposure to cold can prevent the spasms from occurring. This may require the use of insulated boots and thick warm socks, which are available in most sporting goods stores. Smoking cessation can also help, as cigarette smoke can lead to vasospasm in the hands and feet of people with Raynaud’s disease.
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In the case of cerebrovascular vasospasm, medication to open blood vessels can be prescribed. Medications that relax the muscles within the walls of the blood vessel are used to prevent clots and increase blood flow, thus decreasing the risk of stroke or heart attack.
For subarachnoid hemorrhages (SAHs), there is no known prevention of the type of vasospasm that occurs in the small arteries and arterioles surrounding the brain. However, early treatment of SAH decreases the chance that complications such as vasospasm will occur. For coronary vasospasm, nitroglycerin or another fast-acting nitrate can be given to relax constricted arteries and prevent a heart attack.
