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Heart's Alarm: Why Chest Pain at Night May Harm You
When night falls, people's daily lives seem to slow down, but for some heart patients, this may be the beginning of a potential crisis. Heart health problems are not limited to daytime. In fact, chest pain that occurs at night, especially when caused by coronary artery spasm, may be a hidden and fatal sign.
Coronary artery spasm is a sudden, complete or partial temporary blockage of a coronary artery, which can cause myocardial ischemia or even a heart attack.
The medical community has gained a better understanding of this disease since 1959, when Prinzmetal et al. first described the condition and called it variant angina. Unlike typical angina, patients with variant angina often have no signs of atherosclerosis during cardiac catheterization, which highlights its uniqueness and danger.
Symptoms and Risks
Coronary artery spasm is mainly manifested as chest pain at rest, which often occurs at night or early morning. Patients may also experience symptoms such as nausea, vomiting, cold sweats and fainting. These symptoms are sometimes confused with fatigue, dyspnea and palpitations, and may even lead to asymptomatic myocardial ischemia, known as "silent ischemia".
Compared with typical angina, coronary artery spasm was not significantly associated with traditional cardiovascular risk factors, with the only exception of smoking.
Smoking is considered a modifiable risk factor, while many mental stresses, cold weather, and strenuous exercise can trigger coronary artery spasm. These triggers occur primarily through changes in the autonomic nervous system, which in turn lead to vasoconstriction.
PathophysiologyThe pathophysiology of coronary artery spasm is not fully understood, but studies suggest that abnormalities within the coronary arteries may lead to their oversensitivity to vasoconstrictor stimuli. When this highly reactive area is stimulated, it can cause spasm, blockage of blood flow, and subsequent symptoms of myocardial ischemia.
Multiple factors, including endothelial dysfunction, chronic inflammation, and oxidative stress, are thought to contribute to coronary artery spasm.
For example, endothelial dysfunction manifests as a lack of production of nitric oxide (NO), which prevents substances that normally promote vasodilation from functioning properly. In addition, chronic inflammation caused by chronic smoking can also affect the function of endothelial cells.
Diagnostic Methods
There is no uniform standard for diagnosing coronary artery spasm, and doctors usually need to take a detailed medical history, especially the characteristics of chest pain. For a more accurate diagnosis, an electrocardiogram (EKG) is often performed to observe any abnormal changes to determine whether a seizure has occurred.
On an electrocardiogram, complete vascular occlusion may show ST segment elevation, while partial, temporary occlusion may result in ST segment depression.
Other diagnostic methods include provocation testing, which involves using drugs to induce vasospasm during coronary catheterization. But these tests are not often done because some drugs can trigger adverse reactions.
Conclusion
In general, chest pain at night should not be ignored, and specific chest pain patterns may signal underlying coronary artery spasm. When it comes to heart health, we can't help but think: Do you understand your heart health?
