What are alternate approaches to medical therapy and/or interventions to consider in patients with refractory, severe coronary vasospasm despite short-acting nitrates, calcium channel blockers, L-arginine, and clonidine?   

Angina caused by coronary vasospasm is relatively rare. I have come across very few cases of severe coronary vasospasm in my 15 years of career. The most common thread seems to be smoking and drug abuse (amphetamines, cocaine). Smoking cessation and stopping drug abuse are the most important interve...

I would try to identify any provoking scenarios if possible. Some of my patients with recurrent spam continue to smoke for instance. One other issue we encounter frequently is patients not taking sufficient amounts of L-arginine (2-3 grams three times a day). OTC L-arginine tablets are bulky and the...

Many patients with coronary vasospasm have some degree of atherosclerosis, and statin therapy for a low target LDL cholesterol is appropriate. Complete avoidance of tobacco is necessary. 

The issue with the diagnosis of "coronary spasm" is sometimes a wastebasket diagnosis. Hence the variability among providers in encountering it, from "I rarely see it" to "it is very common in my practice". How do we define it? Is this clinical diagnosis based on clinical suspicious or is it confirm...

Again, ECP maybe an option for some patients with refractory angina where optimized meds fail and surgical or intervention is not possible.