The human body is indeed a marvel. Just take an example of the blood circulation system. It consists of the blood vessels and the heart as its engine. The length of the blood vessel itself is about 100 000 kilometres inside the body. It is fascinating that this long length of blood vessels is able to ensure blood flow properly in the body. In this DoctorOnCall’s article, we will be learning about one of the diseases that is caused by temporary reversible dysfunction of the blood vessels known as vasospasm.
Vasospasm is a condition of the sudden contraction of the muscular walls of the blood vessels that lead to narrowing of the blood vessels and blocking the blood flow. Vasospasm can affect any part of the body, commonly in the brain and the coronary artery of the heart. From here on, we will emphasise on vasospasm according to the organ affected, focusing one heart and the brain.
Vasospasm of the brain
Also known as cerebral vasospasm, usually follows days after another disease affecting the brain known as a subarachnoid haemorrhage (SAH). SAH is a type of stroke that happens when the blood vessels on the surface of the brain breaks. The bleeding occurs in the space below one of the thin layers that cover and protect the brain. SAH is usually caused by a burst blood vessel in the brain, typically a ruptured brain aneurysm. Brain aneurysm is a weak or thin spot on a blood vessel, usually artery, that balloons or bulges due to the blood that has filled in it. SAH may also occur after a trauma to the head but it is rather rare to be causing vasospasm. SAH is the most dangerous type of stroke because it is able to lead a person to coma or a person being paralyzed. Some might survive a SAH but then will have cerebral vasospasm again and put a person’s life in danger for the second time.
When a person is diagnosed with SAH, the doctor will monitor the patient and seek signs of possible cerebral vasospasm. Signs include confusion, stiff neck, paralysis of one side of the body, numbness or weakness on one side of the body, loss of balance, speech impairment, visual disturbances, walking difficulties and severe headaches.
Imaging test is usually done by a doctor to look for the SAH sign or other causes leading to the cerebral vasospasm. Imaging tests such as cerebral angiography, transcranial doppler ultrasound, CT or MRI scan are among the imaging tests commonly asked by doctors to help diagnose SAH and vasospasm.
Treatments depend on the severity of the condition. Patients may be transferred to the intensive care unit (ICU) if their condition is severe. If an imaging test shows brain aneurysm to be the cause of the SAH, surgery repair is usually considered to repair the blood vessels and prevent further aneurysm from bursting in the future. Doctors usually prescribed calcium channel blockers such as nimodipine to protect the brain from the complications that cause the blood supply to the brain to be disrupted and lead to brain damage. Other medications to support patient’s general wellbeing such as pain relief, antiemetics and anticonvulsants may be prescribed to patients to ease symptoms.
Coronary artery vasospasm
Vasospasm that occurs in the artery that supplies blood to the heart. It is also known as Prinzmetal angina or variant angina. Vasospasm happens when the chemical messengers controlling the heart are disrupted. There are many causes that can cause this vasospasm. This includes transition from sleep to awake, hyperventilation (rapid deep breathing), sudden drop or extreme temperature of surrounding, emotional stress such as anxiety, drinking excessive alcohol, legal or illegal drugs and certain herbal supplements.
Symptoms of coronary artery vasospasm usually happen when a person is taking rest, most often in the early morning or at night. Symptoms seem similar to a heart attack of chest pain or pressure on the chest and pain that spreads to the jaw, arm or back. Vasospasm in healthy people may not be a serious issue but when it occurs in people with coronary artery disease, it may cause a heart attack and heart damage.
Since it can be difficult to distinguish coronary artery vasospasm with typical heart attack, doctors will initially rule out other heart conditions that could have caused the symptoms. Further tests such as angiography are done to get a clear look of the artery.
Treatments usually are sublingual glyceryl trinitrate tablets or spray to relieve symptoms and calcium channel blocker or beta blockers to prevent or reduce the spasm frequency. In certain cases where medications do not work to relieve the vasospasm, surgery such as coronary stenting may be considered. Patients that present with arrhythmia (abnormal heart rhythm) and coronary artery vasospasm may be offered with implantable cardioverter-defibrillators.
In essence, cerebral vasospasm and coronary artery vasospasm can cause life-threatening events when it is not treated well. It is best to seek medical attention when a person is presented with any sign or symptoms associated with vasospasm.
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