Vasospasm

What is a vasospasm?

A vasospasm is a lengthy constricting, narrowing or tightening in your artery. This reduces blood flow through the artery, sending less oxygen than normal to nearby tissues.

Your arteries expand and contract their muscular walls regularly to help control the pressure of blood moving through them. Because vasospasms last longer than a normal constriction, they can damage the layers of your artery walls. It’s like clenching your fists for too long.

Vasospasm is more likely to happen in abnormal areas of blood vessels (endothelial dysfunction).

What happens during a vasospasm?

During a vasospasm, smooth muscle overreacts to signals to constrict. Normally, these muscles have a temporary response to a signal to tighten an artery wall. During a vasospasm, the muscles constrict longer than they should.

How does a vasospasm affect my body?

Vasospasms happen in various arteries, but they happen more often in some arteries than others. These include your heart and brain.

A vasospasm’s effects vary depending on where they happen, for example:

• Coronary vasospasms (Prinzmetal angina) can limit blood flow to your heart and cause a heart attack.
• A cerebral vasospasm can cause reduced blood flow leading to a cerebral infarct (like a heart attack in your brain).
• Vasospasms in your fingers and toes are uncomfortable.
• A nipple vasospasm can make it difficult to breastfeed (chestfeed).

How common is a vasospasm?

An estimated 20% of childbearing people may have vasospasm in their nipples during breastfeeding (chestfeeding). As many as 50% to 90% of people with an aneurysm rupture in their brain get a vasospasm.

What are the symptoms?

Vasospasm symptoms are different depending on where the vasospasm happens.

Coronary (heart) vasospasms

These happen at rest, at night, in the early morning and in the cold. Researchers also have linked them to anxiety and depression.

Coronary vasospasm symptoms include:

• Cardiac arrest or aborted sudden cardiac death.
• Fainting.
• Stable angina.
• Acute coronary syndrome.

Cerebral (brain) vasospasms

Cerebral vasospasm symptoms include:

• Sudden, severe headache that gets worse within seconds.
• Drowsiness.
• Inability to move your limb or one side of your body.

Finger or toe vasospasms

Symptoms of a vasospasm in your finger or toe include:

• Coldness or numbness.
• Skin color changes.
• Throbbing or tingling.

Nipple vasospasms

Symptoms of nipple vasospasm in those who breastfeed (chestfeed) include:

• Nipple pain.
• Color change in nipples from white to red to blue or purple.

What causes a vasospasm?

Vasospasms in various parts of your body have different causes.

Coronary vasospasm

Direct causes aren’t well understood, but conditions and causes that are associated with coronary vasospasm include:

• Serotonin.
• Chemotherapy.
• Cocaine, amphetamines or cannabis.
• Genetic mutation.
• Inflammation.
• Migraines.

Cerebral vasospasm

Cerebral vasospasm causes include:

• Ruptured brain aneurysm.
• Other causes of bleeding around your brain.
• Exposure to vasoactive substances or medications.
• Subarachnoid (around your brain) blood clot.

Vasospasm in fingers or toes

Causes of vasospasms in your fingers and toes include:

• Raynaud’s phenomenon.
• Scleroderma.
• Atherosclerosis.
• Blood clots.

Vasospasm in nipples while breastfeeding (chestfeeding)

Nipple vasospasm causes include:

• Raynaud’s phenomenon.
• Certain medicines.
• Breast surgery.
• Autoimmune disease.
• Exposure to cold.
• Unlatching baby.
• Topical antifungals and All-Purpose Nipple Ointment (APNO) cream.
• Poor latch or pump-induced nipple trauma.
• Tobacco use.
• Unknown.

How is a vasospasm diagnosed?

A provider’s physical exam can be a key part of making their diagnosis, but these tests are important, as well:

• Electrocardiogram (EKG).
• An angiogram after injecting medicine in your coronary artery to start a spasm.
• Positron emission tomography (PET).
• Computed tomography (CT).
• Magnetic resonance imaging (MRI).
• Echocardiogram.

What is the treatment for vasospasm?

Vasospasm treatments vary depending on where in your body the vasospasm is happening.

Coronary artery vasospasm

Treatments for a coronary artery vasospasm include:

• Taking calcium channel blockers.
• Taking nitrates.
• Losing weight.
• Stopping the use of recreational drugs and tobacco products.
• Getting an implantable cardioverter defibrillator (ICD) if you have ventricular tachycardia.

Cerebral vasospasm

Cerebral vasospasm treatments include:

• Increasing fluid intake.
• Increasing blood pressure.
• Removing the trigger that’s causing vasospasms.
• Giving a vasodilator like verapamil orally or nimodipine through an IV (intravenous, through your vein).
• Rarely, giving intra-arterial vasodilators if needed.

Vasospasm in fingers or toes

Treatments for vasospasms in fingers or toes include:

• Wearing gloves, mittens and other warm clothes.
• Avoiding the use of tobacco products.
• Taking calcium channel blockers like felodipine or amlodipine (Norvasc® or Katerzia®).
• Having surgery or a botulinum toxin injection.

Nipple vasospasm

Treatments for nipple vasospasms include:

• Applying warmth and keeping nipples covered.
• Avoiding things that make blood vessels constrict, such as tobacco use.
• Taking nifedipine (Nifedical®XL or Procardia®XL), a calcium channel blocker or a selective serotonin reuptake inhibitor (SSRI) is sometimes necessary if vasospasms continue despite the above measures.

Side effects of the treatment

Medicines for treating vasospasms may cause:

• Headache.
• Upset stomach.
• Dizziness.
• Lightheadedness.
• Seizures.

How can I reduce my risk of vasospasms?

Some of the ways to reduce your risk of vasospasms are things that are good for your heart and blood vessel (cardiovascular) health in general, such as:

• Don’t use tobacco products.
• Keep your cholesterol numbers in a normal range.
• Limit your use of alcohol.
• Manage Type 2 diabetes.
• Manage high blood pressure.
• Avoid using cocaine.

How can I prevent a vasospasm?

To prevent a cerebral vasospasm, a provider may:

• Go through your medication list to assure that you aren’t on any vasoactive medications.
• Prevent high intracranial (within your brain) pressure.
• Give you nimodipine or verapamil, a calcium channel blocker.

Are vasospasms serious?

Vasospasms that happen in your fingers, toes or nipples may be painful and bothersome. However, they’re not life-threatening.

When a vasospasm happens in your heart or brain, the lack of blood flow to those organs can destroy tissue. This can have a severe impact on how well your heart and brain function.

Heart attacks can happen in less than 5% of cases of coronary vasospasms. However, treatments for heart attacks improve your quality of life.

People who have severe brain vasospasms may be in the hospital for weeks.

How do I take care of myself?

Keep taking the medicines your healthcare provider prescribed. Contact your provider if your symptoms don’t get better. Avoiding the things that can start a vasospasm may help you prevent them. Seek immediate care if you’re having symptoms of a heart attack.

What questions should I ask my doctor?

• Are there other medications I could take if your first choice doesn’t help?
• Can you refer me to a provider who can help me with breastfeeding/chestfeeding issues?
• How often do I need follow-up appointments with you?
• What’s the prognosis for my specific situation?

A note from Cleveland Clinic

Different treatments are available for the various kinds of vasospasms that can happen. But for some types of vasospasms, you have the power to make changes that can prevent them. Talk to your provider about making a plan for treating and possibly preventing vasospasms.