Would coronary spasm show on ecg or troponin always? os 180mg of calcium channel blocker a high starting dose? afraid of the side effects?

In severe coronary artery spasm there may be transient abnormalities of the ST-T waves of the EKG and occasionally troponins can be elevated. Verapamil,a calcium channel blocker, can be given at 80 mgs, 120 mgs, 180 mgs, 240mgs,360mgs or even 480mgs. We often start with 120 mgs and work upwards as needed. Slow heart rate,low blood pressure & constipation are the usual side effects I've seen

"Always" is not a term applicable to most medical tests. If spasm was demonstrated on angiography and accompanied by symptoms and ECG abnormality, the suspicion is verified, and a channel drug might be helpful. Since this is of some importance, please have a full discussion with your cardiologist and ask for follow up to evaluate the response. Please follow up.