Vasospastic Acute Coronary Syndromes as a Manifestation of Endothelial Dysfunction and the Role of Flow Mediated Dilatation Test

There are many evidences and randomized clinical trials on management and treatment of acute coronary syndromes (ACS’s) caused by atherotrombotic mechanisms, in opposition to those ACS’s that present no evidence of having been caused by a thrombotic event and/or atherosclerotic disease. We believe that endothelial dysfunction is the pathophysiological key behind most coronary spams, both epicardial and microvascular, after the ruling out evident secondary causes. In this article we describe four different clinical scenarios of vasospastic ACS’s, the potential role of flow mediated dilatation test and we generate an algorithm that will help guide clinical management.