Understanding Prinzmental Angina: Causes, Symptoms, and Management

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Prinzmental Angina

by Alike Medical Team ∙ Updated on June 13, 2023

General

Prinzmetal angina, or vasospastic angina, is caused by a spasm in a coronary artery - the arteries that supply blood to the heart. Coronary artery spasm can produce ischemia (oxygen starvation) in the part of the heart muscle supplied by the affected artery, and angina results. While Prinzmetal angina can have important consequences, including heart attack and life-threatening cardiac arrhythmias, it can almost always be treated very effectively, once it is correctly diagnosed.

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Signs & symptoms

The chest pain that people experience with Prinzmetal angina is indistinguishable from classic, typical angina caused by atherosclerosis. As with typical angina, people with Prinzmetal angina will often describe one or more of several symptoms, including chest tightening, squeezing, pressure, fullness, a weight or knot in the chest, aching, or a burning sensation. Such chest “discomfort” may be accompanied by shortness of breath, nausea, or sweating, and/or palpitations. These symptoms often persist for 15 minutes or more. And in contrast to typical angina, which usually occurs during exertion or stress, Prinzmetal angina more typically occurs while at rest. In fact, people most frequently experience Prinzmetal angina at the quietest time of the day —between midnight and early morning.

Diagnosis

Prinzmetal angina occurs when an area within one of the major coronary arteries suddenly goes into spasm, temporarily shutting off blood flow to the heart muscle supplied by that artery. During these episodes, the electrocardiogram (ECG) shows dramatic elevations of the "ST segment" — the same ECG changes commonly seen with heart attacks. Nitrates usually relieve the spasm very quickly, returning the coronary artery back to normal. So, the things doctors look for to diagnose Prinzmetal angina are: - typical “anginal” chest pain, accompanied by dramatic changes on the ECG, which are relieved by nitrate administration, with “normal’ coronary arteries demonstrated on cardiac catheterization.

Treatment

It is important to control all cardiac risk factors. Especially critical to avoid tobacco products, which are powerful stimulants of coronary artery spasm. - Calcium channel blockers are often the first line agent used for vasospastic angina. If additional medication is required, a nitrate may be added to a calcium channel blocker. - Also, a statin might be needed — a class of drugs that not only lower cholesterol but also improve endothelial function — as recent data suggests that statins can help to prevent coronary artery spasm. - Drugs that can trigger coronary artery spasm that should be avoided include many beta-blockers and some migraine drugs — in particular, Imitrex (sumatriptan). Aspirin should be used with caution as it may exacerbate vasospastic angina.

Note

☝ We provide information on prescription and over-the-counter medicines, diagnosis, procedures and lab tests. This material is provided for educational purposes only and is not medical advice, diagnosis or treatment.

National Institutes of Health ∙ World Health Organization ∙ MedlinePluse ∙ Centers for Disease Control and Prevention

☝ All information has been reviewed by certified physicians from Alike

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