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5th Edition of Cardiology World Conference

September 5-7, 2024 | Madrid, Spain

September 05 -07, 2024 | Madrid, Spain
CWC 2019

Coronary artery spasm: Pathogenesis, diagnosis and treatment

John Horowitz , Speaker at Cardiovascular Conference
University of Adelaide, Australia
Title : Coronary artery spasm: Pathogenesis, diagnosis and treatment


Coronary artery spasm (CAS) may involve predominantly large or small coronary arteries, and usually presents as episodes of prolonged ischaemic-type chest pain occurring randomly, but with a tendency toward cyclic periodicity. Diagnosis is currently difficult clinically, and many patients are discharged from Emergency Departments because of lack of clinical evidence of cardiac injury. However, precipitation of CAS following intracoronary injection of acetylcholine is diagnostic, and implies a relative impairment in the indirect, nitric oxide (NO)-mediated, coronary vasodilator component of acetylcholine effect. Recently it has become apparent that many patients with acute episodes of CAS have evidence of erosion of intracoronary atherosclerotic plaques, sometimes with associated intracoronary thrombus formation. These finding raise the possibility that some form of vascular-platelet interaction occurs during symptomatic crises in such patient, rather than just an aggravation of coronary constrictor tone.We have therefore compared platelet  anti-aggregatory responses to the autacoids NO and prostacyclin (PGI2 ) in normal subjects and patients with CAS, both in chronic and acute symptomatic phases. Responsiveness to NO and PGI2  were markedly and significantly ( p<0.01 for both) impaired during the chronic phase in comparison with normal data, and tended to worsen during symptomatic crises.  These results therefore suggest that CAS may reflect, perhaps primarily, a propensity towards platelet/endothelial interactions within the coronary vasculature, and that it may represent a microcosm of a generalized disorder in this respect. Results of further experiments further  evaluating pathogeneic mechanisms, and probing appropriate diagnostic and therapeutic options for CAS during both acute and chronic phases, will be presented.


Professor John Horowitz trained in Medicine in Adelaide, with subsequent clinical and research training in Cardiology and Clinical Pharmacology at the University of Melbourne. From 1980 to 1982 he was a postdoctoral research fellow at the Brigham and Women’s Hospital, Harvard University, Boston. In 1988 he was appointed as Director of Cardiology at the Queen Elizabeth Hospital, Adelaide, and Professor of Cardiology, Adelaide University. His major research interests centre on the pathogenesis and potential treatment of various forms of cardiovascular disease, including myocardial ischaemia, heart failure, atrial fibrillation, aortic valve stenosis and takotsubo syndrome. Among his specific pharmacological/therapeutic interests are the potential utilities of the cardiac metabolic manipulator perhexiline and the antioxidant N-acetylcysteine.