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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Oct 26, 2025; 17(10): 108594
Published online Oct 26, 2025. doi: 10.4330/wjc.v17.i10.108594
Published online Oct 26, 2025. doi: 10.4330/wjc.v17.i10.108594
Vasospastic angina: Pathophysiology, diagnosis, and emerging therapeutic approaches
Kristoffer Ken Ralota, Department of Cardiology, Peninsula Health, Frankston 3199, Victoria, Australia
Jamie Layland, Department of Cardiology, Peninsula Health and Department of Medicine, Peninsula Clinical School, Monash University, Frankston 3199, Victoria, Australia
Co-corresponding authors: Kristoffer Ken Ralota and Jamie Layland.
Author contributions: Ralota K drafted and prepared the manuscript; Layland J supervised the writing of the manuscript, including its conceptualization and review. Both authors have read and approved the final manuscript. Ralota K drafted the manuscript, its content, flow, and narrative, helped in vetting of related literature for inclusion of their contents into this manuscript, enacted necessary revisions of the manuscript, preparation and submission of the current version of the manuscript. Layland J is the senior researcher who conceptualized the manuscript, was responsible for reviewing revisions of the manuscript, helped in vetting of related literature for inclusion of their contents into this manuscript, and supervised the entire process. This collaboration between Ralota K and Layland J is crucial for the publication of this manuscript.
Conflict-of-interest statement: All authors declare no conflicts of interest.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jamie Layland, MD, PhD, Consultant, FRACP, MRCP, Professor, Senior Researcher, Department of Cardiology, Monash University, 2 Hastings Road, Frankston 3199, Victoria, Australia. jlayland@phcn.vic.gov.au
Received: April 18, 2025
Revised: May 31, 2025
Accepted: September 19, 2025
Published online: October 26, 2025
Processing time: 189 Days and 19.4 Hours
Revised: May 31, 2025
Accepted: September 19, 2025
Published online: October 26, 2025
Processing time: 189 Days and 19.4 Hours
Core Tip
Core Tip: Vasospastic angina (VSA) is an under-recognized but clinically significant cause of myocardial ischemia, arrhythmia, and sudden cardiac death in patients without obstructive coronary artery disease. This narrative review provides an up-to-date revision of VSA pathophysiology, diagnostic strategies including provocation testing, and current guideline-recommended management. It also highlights promising emerging therapies—such as Rho-kinase inhibitors, endothelin receptor antagonists, and immunomodulatory agents—offering new hope for patients with refractory symptoms. Reco