What Is Vasospasm?

Rapid Narrowing of One or More Blood Vessels

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Vasospasm is the abrupt narrowing of one or more blood vessels. Cerebral vasospasm, the narrowing of arteries in the brain, is typically triggered by a serious event, such as a ruptured brain aneurysm.

The effects of cerebral vasospasm can include seizures and loss of consciousness. The condition requires urgent treatment. Vasospasm can also affect the blood vessels of the heart or the systemic circulation. 

Vasospasm can be treated with medication

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Types of Vasospasm 

Vasospasm can affect any blood vessel in the body, but it is most common in the arteries. These are the large blood vessels that carry oxygen-rich blood to organs so they can function. 

The most commonly described types of vasospasm are:

  • Cerebral vasospasm: This is sudden constriction (narrowing) of one or more arteries in the brain. 
  • Coronary vasospasm: Also called cardiac vasospasm, this is a narrowing of the arteries that supply blood to the heart muscle. 
  • Systemic vasospasm: This can affect small arteries or capillaries in the extremities. It is most often caused by Raynaud’s disease, a systemic vascular condition. 

Vasospasm can also occur in other areas of the body and may play a role in conditions like glaucoma, for example.

Vasospasm Symptoms 

Rapid narrowing of an artery can cause a substantial decline or a complete blockage of blood flow to the destination tissue. This may cause diminished function or complete necrosis (death) of the blood-deprived region of the body.

Vasospasm can develop over the course of hours or several days. Symptoms will differ, depending on which part of the body is deprived of blood flow. 

Cerebral Vasospasm 

Vasospasm of arteries in the brain can cause a deficiency in brain function, such as stroke-like symptoms. It can also cause a stroke if the blood flow does not partially resume within a few minutes.

Symptoms of cerebral vasospasm can include:

  • A severe headache 
  • Partial or complete vision loss
  • Weakness on one side of the body
  • Convulsions
  • Confusion and difficulty communicating 
  • Change in consciousness or loss of consciousness 

The effects of cerebral vasospasm develop and progress quickly. If it causes a stroke, it may result in lasting neurological consequences. Sometimes cerebral vasospasm may be fatal.

Often, before cerebral vasospasm occurs, there is a history of other symptoms, such as head pain or neurological changes due to a recently ruptured brain aneurysm or a procedure. This can make it especially challenging to recognize the effects of vasospasm. Your doctors will monitor your neurological function to promptly identify this problem. 

Coronary Vasospasm 

Narrowing of the blood vessels in the heart can cause severely diminished blood flow to the heart muscle. This can cause dizziness, angina (chest pain), or shortness of breath.

If the blood flow does not resume within a few minutes, coronary vasospasm can cause a heart attack. Symptoms of this can include:

  • Dizziness
  • Extreme chest pain
  • Chest pressure
  • Shortness of breath
  • Arm pain
  • Loss of consciousness 

A heart attack can cause damage to the muscles of the heart. Long-term consequences include heart failure, which results in fatigue, low energy, exercise intolerance, and shortness of breath. The lasting consequences of a heart attack can also include intermittent dizziness due to an irregular heart rate

A heart attack is a life-threatening event. 

Systemic Vasospasm

Vasospasm can affect any part of the body, but it is not common unless there is an underlying condition. For example, in Raynaud's disease vasospasm can cause the fingers or toes to become cold, numb, tingly, pale, or bluish. 

Rarely, vasospasm in the extremities can cause pain.  

Causes 

Generally, vasospasm refers to a relatively abrupt narrowing, and not the gradual vascular narrowing that can occur due to chronic vascular disease. Vasospasm can happen due to certain risk factors or underlying medical issues.

Causes of vasospasm include:

  • Nearby bleeding
  • Severe ischemia (lack of blood flow)
  • Medications
  • Drugs of abuse
  • Severe blood pressure or fluid changes
  • Organ failure
  • Inflammation

These issues can occur suddenly, but they can be caused by exacerbation (worsening) of a long-lasting problem. Examples are a brain aneurysm that suddenly ruptures or exacerbation of untreated hypertension (high blood pressure).

What Happens in the Body 

The blood vessels throughout the body have smooth muscles in their walls. These are involuntary muscles that perform without conscious effort. Arteries, in particular, have the ability to dilate (widen) and constrict (narrow) due to the normal activity of the smooth muscle. This occurs due to changes in factors such as blood volume or oxygen consumption. 

The vascular muscle can be abnormally reactive in certain situations, leading to the rapid vascular constriction of vasospasm:

  • This can be mediated by changes in calcium concentration. Calcium is necessary for contraction (shortening) of smooth muscles in the blood vessel wall, which leads to tightening of the blood vessels.
  • Cellular changes in the proteins and the endothelium (a type of tissue lining) of the blood vessels can be an underlying factor.

Triggers that can lead to vasospasm can include things like irritation of the blood vessels and surrounding tissue, fluid shifts, blood pressure alterations, or electrolyte (salt) concentration disturbances.

Diagnosis 

Vasospasm is diagnosed based on clinical history, physical examination, and diagnostic testing. Your doctor may examine your extremities to identify systemic vasospasm, looking for changes like discoloration. 

Coronary vasospasm can cause changes that are detectable with electrocardiogram (EKG).

Cerebral or coronary vasospasm is detected with imaging tests that visualize the blood vessels, such as angiography. Sometimes these tests are done with an injected dye that can help distinguish the shape and structure of the involved vessels. 

Treatment 

The treatment of vasospasm involves administration of medication that promotes dilation of blood vessels by relaxing the smooth muscle in the blood vessel walls. Generally, medication would be injected intravenously (IV, in a vein) or intra-arterially, but more direct therapy can be used in some instances as well.

Medications that can be used include:

  • Calcium channel blockers like nitroglycerine for treating coronary vasospasm or nicardipine for treating cerebral vasospasm
  • Vasodilating (makes blood vessels open wider) medications like clazosentan
  • Magnesium (has vasodilatory action)
  • Blood thinners like cilostazol (which is also a vasodilator) or heparin to help prevent blood clots
  • Statin drugs, which lower cholesterol

To prevent recurrent vasospasm, ganglion block is sometimes used. This procedure prevents nerve stimulation that is believed to impact the blood vessel action.

Prognosis and Coping

The prognosis of vasospasm can be very good if it is treated before serious complications occur. Over the long term, blood pressure can be managed, and risk factors can be controlled.

If you have a condition that causes recurrent vasospasm, such as untreated hypertension or Raynaud’s disease, it is important to talk to your doctor about prevention. This will involve a combination approach that includes lifestyle adjustments and medication.

Summary

Vasospasm is the sudden narrowing of a blood vessel. Cerebral and coronary vasospasm may result in a stroke or heart attack. It can be triggered by several causes, including bleeding, drugs, or severe changes in blood pressure. It is treated with medications that open up the blood vessels and prevent clots.

A Word From Verywell

Vasospasm is a serious problem, especially when it affects the blood vessels of the brain or the heart. When there is a high risk of vasospasm, medical treatments are used to prevent it, and the condition is monitored so that early signs of vasospasm can be identified and treated.

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