Vasospasm
Vasospasm is a sudden, prolonged tightening of blood vessels that reduces blood flow to the tissues they supply. While it can occur in many parts of the body, vasospasms affecting the heart and brain are the most serious, as they can lead to heart attack or stroke. Understanding the symptoms and seeking proper treatment can help manage this condition effectively.
Table of contents
- What is vasospasm?
- Where vasospasm occurs in the body
- Symptoms of vasospasm
- Causes and risk factors
- How vasospasm is diagnosed
- Treatment options
What is vasospasm?
A vasospasm is a lengthy narrowing or tightening of an artery that lasts longer than a normal constriction. This reduces blood flow through the artery, sending less oxygen than normal to nearby tissues and organs[1]. The term “vasospasm” comes from “vaso” meaning vessel, and “spasm” meaning a sudden, involuntary muscle squeeze[3].
Your arteries normally expand and contract their muscular walls regularly to help control blood pressure. During a vasospasm, smooth muscle in the artery wall overreacts to signals to constrict. The muscles tighten longer than they should, which can damage the layers of your artery walls[1]. It’s similar to clenching your fists for too long.
Vasospasm is more likely to happen in abnormal areas of blood vessels, a condition known as endothelial dysfunction[1].
Where vasospasm occurs in the body
- Brain (cerebral arteries)
- Heart (coronary arteries)
- Fingers and toes
- Nipples
Vasospasms can happen in various arteries throughout the body, but they occur more often in some locations than others[1].
Cerebral vasospasm affects the blood vessels in the brain. This most commonly occurs after a subarachnoid hemorrhage (a type of bleeding stroke), often caused by a ruptured brain aneurysm[3][4]. Between 50% to 90% of people with an aneurysm rupture in their brain develop vasospasm[1]. The narrowing typically occurs 3 to 15 days after the initial hemorrhage, with a peak at 7 to 10 days[5][7]. While up to 70% of patients may show radiographic evidence of vasospasm, only about 30% will develop symptoms severe enough to require treatment[5].
Coronary vasospasm, also called Prinzmetal angina or variant angina, affects the arteries that supply the heart[1][8]. This type can limit blood flow to your heart and potentially cause a heart attack[1]. These spasms often happen at rest, at night, in the early morning, or in cold weather[1].
Vasospasms in the fingers and toes are often related to Raynaud’s phenomenon, a condition that affects blood vessels’ response to temperature changes[1][2].
Nipple vasospasm during breastfeeding affects an estimated 20% of women[1]. This can cause significant pain and may make breastfeeding difficult.
Symptoms of vasospasm
Vasospasm symptoms vary depending on where in the body the narrowing occurs[1].
Coronary (heart) vasospasms
Symptoms of coronary vasospasm include[1]:
- Chest pain, often described as constricting, crushing, pressure, squeezing, or tightness[2]
- Cardiac arrest or aborted sudden cardiac death
- Fainting
- Stable angina
- Acute coronary syndrome
Researchers have also linked coronary vasospasms to anxiety and depression[1].
Cerebral (brain) vasospasms
Symptoms of cerebral vasospasm include[1][3]:
- Sudden, severe headache that gets worse within seconds
- Drowsiness or confusion
- Inability to move your limb or one side of your body
- Numbness or weakness of the face, arm, or leg, especially on one side of the body[2]
- Trouble speaking[2]
- Trouble seeing in one or both eyes[2]
- Fever and neck stiffness[2]
Finger or toe vasospasms
Symptoms in the fingers or toes include[1][2]:
- Coldness or numbness
- Skin color changes (fingers or toes turning purple or blue)
- Throbbing or tingling
- Sharp pain, often described as burning or stinging
Nipple vasospasms
Symptoms in those who breastfeed include[1]:
- Nipple pain
- Color change in nipples from white to red to blue or purple
Causes and risk factors
Vasospasms in various parts of the body have different causes and risk factors[1].
Coronary vasospasm
The direct causes of coronary vasospasm aren’t well understood, but conditions and factors associated with it include[1]:
- Serotonin
- Chemotherapy
- Cocaine, amphetamines, or cannabis
- Genetic mutation
- Inflammation
- Migraines
Patients with atherosclerosis (a condition where fatty deposits build up and harden inside the arteries) are at increased risk of developing coronary artery vasospasms[2].
Cerebral vasospasm
Cerebral vasospasm causes include[1][4]:
- Ruptured brain aneurysm
- Other causes of bleeding around your brain
- Exposure to vasoactive substances or medications
- Subarachnoid (around your brain) blood clot
After a hemorrhage, blood can break down in the area surrounding the affected artery. The vasospasm is a reaction of the arteries to the presence of blood products[4]. Patients who have experienced a hemorrhagic stroke are at increased risk of developing cerebral vasospasm[2].
Vasospasm in fingers or toes
Causes include[1]:
- Raynaud’s phenomenon
- Scleroderma
- Atherosclerosis
- Blood clots
Patients with Raynaud’s phenomenon are at increased risk of developing vasospasms in the toes or fingers[2].
Vasospasm in nipples while breastfeeding
Nipple vasospasm causes include[1]:
- Raynaud’s phenomenon
- Certain medicines
- Breast surgery
- Autoimmune disease
- Exposure to cold
- Unlatching baby
- Topical antifungals
How vasospasm is diagnosed
Diagnosis of vasospasm usually begins with a physical exam and a review of the patient’s medical history and symptoms. For vasospasms that are minor, this is often adequate to diagnose the condition[2].
For more severe conditions, several diagnostic tools are used[2][3]:
Digital subtraction angiography is the gold standard for diagnosing vasospasm. This test allows doctors to directly view the arteries and observe any narrowing[11][14].
Computed tomography (CT) angiography combined with CT perfusion mean transit time is commonly used. This imaging test allows for direct measurement of arterial narrowing and assessment of blood flow[2][11].
Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) can be used to view the blood vessels and observe areas affected by reduced blood flow[2].
Transcranial Doppler (TCD) ultrasound is a useful noninvasive screening and diagnostic tool that measures blood flow velocity through the arteries at the base of the brain. It can be performed repeatedly at the bedside to monitor patients for signs of vasospasm[2][3][11].
If the vasospasm is in the coronary artery, an electrocardiogram (ECG) or an echocardiogram may also be used to diagnose the condition[2].
For cerebral vasospasm, doctors closely monitor patients who have had a subarachnoid hemorrhage by regularly checking their level of consciousness and watching for signs of worsening brain function, which could indicate vasospasm. These signs most often appear within two weeks after the hemorrhage[3].
Treatment options
Treatment of vasospasm depends on the severity of the condition and the area of the body it affects[2].
Medications
Nimodipine, a calcium channel antagonist, is currently the only therapy with proven benefit for reducing the impact of delayed ischemic deficits in cerebral vasospasm[7]. It should be started within 96 hours of subarachnoid hemorrhage and is typically continued for three weeks[5]. While it has been shown to decrease morbidity following aneurysm surgery, its exact mechanism is unknown, and there is no convincing evidence that it directly affects vasospasm itself[5][15].
For all types of vasospasms, medicines can help manage symptoms and improve outcomes[1].
Nitrates, including nitroglycerin administered by various routes (intravenous, topical, or sublingual), effectively treat episodes of angina and heart-related vasospasm within minutes. Long-acting nitrate preparations can reduce the frequency of recurrent events[13].
Calcium channel blockers are also used to treat vasospasm. These medications help relax blood vessel walls and improve blood flow[13].
Hemodynamic therapies
For cerebral vasospasm, treatment approaches include maintaining adequate blood volume and blood pressure. The current recommendation is to target normal blood volume (euvolemia) with isotonic crystalloid fluids and avoid low blood volume, while managing blood pressure that is adjusted based on clinical response[15].
Endovascular treatments
For severe cases of cerebral vasospasm that do not respond to medical treatment, interventional procedures may be necessary. Balloon angioplasty can be used to open narrowed arteries and restore blood flow[4][6]. During this procedure, a small balloon is inserted into the narrowed artery and inflated to widen the vessel.
Additionally, doctors may perform intra-arterial infusion of vasodilator drugs directly into the affected blood vessels to help relax and widen them[7][14].
Preventive measures and home care
For vasospasms in the fingers, toes, or nipples, keeping warm is essential. Avoiding exposure to cold temperatures can help prevent episodes[2].
For nipple vasospasm during breastfeeding, applying warmth immediately after nursing and keeping nipples covered can provide relief. Ensuring proper positioning and attachment of the baby during breastfeeding is also important to prevent nipple trauma that can trigger vasospasm[16][17].
Smoking and drinks containing caffeine may make vasospasm worse and should be avoided[18].
