Many vasospastic angina symptoms, such as chest pain and shortness of breath, are similar to those of classic angina. This is one reason for why people should see a healthcare provider in order to determine the cause.
This article explains Prinzmetal angina causes, the differences in who it affects and why they may have risk factors, as well as prognosis and treatment for the condition.
What Is Prinzmetal Angina?
Angina is not always caused by the blockages produced by typical coronary artery disease (CAD). Sometimes angina can occur in people whose coronary arteries are entirely clear of atherosclerotic plaques. In some people, angina can occur because of a sudden spasm in one of the coronary arteries—the arteries that supply blood to your heart.
Prinzmetal angina, or variant angina, is caused by such a spasm in a coronary artery. These spasms can produce ischemia (oxygen starvation) in the part of the heart muscle supplied by the affected artery, and the symptoms of angina follow.
While Prinzmetal angina can have important consequences, including heart attack and life-threatening cardiac arrhythmias, it can almost always be treated effectively, once it is correctly diagnosed.
Prinzmetal Angina 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 or squeezing Pain that may radiate to arms, shoulders, jaw, neck, upper abdomen, or back A sense of pressure or fullness A weight or knot in the chest Aching or a burning sensation Shortness of breath (dyspnea) Nausea Weakness or fatigue Sweating (diaphoresis) Heart palpitations
These symptoms often persist for 15 minutes or more. 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.
Who Gets Prinzmetal Angina?
Prinzmetal angina is more common in women than in men. People with this condition are often relatively young, quite healthy, and commonly have very few risk factors for typical heart disease—with the exception of smoking.
Smoking is a major factor in provoking angina in people with this condition because tobacco products can cause arterial spasm. The autonomic nervous system may play a role as well.
Cocaine or amphetamines can also provoke Prinzmetal angina. Substance abusers with Prinzmetal angina are much more likely to suffer permanent (or fatal) heart damage than non-substance abusers who have this condition.
Endothelial dysfunction, a condition in which the inner lining of the arteries does not work normally, may be a factor but is not the main cause. Endothelial dysfunction is also associated with cardiac syndrome x, Raynaud’s phenomenon, and migraine headaches. And as it turns out, people with Prinzmetal angina often are also migraine sufferers.
How Prinzmetal Angina Is Diagnosed
Prinzmetal angina occurs when one of the major coronary arteries suddenly goes into spasm, temporarily shutting off blood flow to an area of heart muscle supplied by that artery. During these episodes, the electrocardiogram (ECG) shows 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.
In many cases, a person sees their healthcare provider after the angina has gone away. In these instances, diagnostic testing may include ambulatory ECG monitoring for a period of a few weeks (looking for spontaneous episodes of angina accompanied by ECG changes) or stress testing.
Sometimes, a procedure called cardiac catheterization with “provocative testing” is necessary to make a diagnosis. Because Prinzmetal angina is caused by coronary artery spasm rather than by a fixed blockage in the artery, the catheterization usually shows “normal” coronary arteries.
Further, because Prinzmetal angina is not the only kind of chest pain that can be seen with normal coronary arteries, making the correct diagnosis may require that the coronary artery spasm be provoked.
With a hyperventilation test, the patient is instructed to breathe deeply and rapidly for a full six minutes—which is much more difficult to do than it may sound—while an ECG is being continuously recorded, and echocardiography is done to look for signs of coronary artery spasm.
This test is especially useful in people who have frequent episodes of severe Prinzmetal angina. It tends not to be nearly as useful in those whose episodes are more sporadic or infrequent.
Acetylcholine and ergonovine are two drugs often used to attempt to induce coronary spasm during a cardiac catheterization. This kind of testing yields a correct diagnosis more reliably than the hyperventilation test. Testing with acetylcholine is considered safer than testing with ergonovine and is the preferred invasive provocative test.
Outlook and Consequences
The outlook for people with Prinzmental angina is generally quite good, but this condition can lead to dangerous and potentially fatal cardiac arrhythmias. The type of arrhythmia provoked depends on which coronary artery is involved.
For example, if the right coronary artery is involved, it could cause a heart block. If the left anterior descending artery is involved, it might result in ventricular tachycardia.
While heart attacks are uncommon with Prinzmetal angina, they can occur and produce permanent heart muscle damage. Adequate treatment of Prinzmental angina greatly reduces the risk of such complications.
Treatment
If you have Prinzmetal angina, it will be important for you (as it is for everyone) to control your cardiac risk factors. In your case, it is 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 treatment. If additional medication is required, a nitrate may be added to a calcium channel blocker.
Also, you might discuss the use of a statin (a class of drugs that not only lower cholesterol but also improve endothelial function) with your healthcare provider. Recent data suggest that statins can help to prevent coronary artery spasm.
Be aware that some drugs can lead to a coronary artery spasm. Generally, you should avoid many beta-blockers, and some migraine drugs like Imitrex (sumatriptan). Aspirin should be used with caution, as it may exacerbate vasospastic angina.
A Word From Verywell
Prinzmetal angina is a rare condition that produces angina due to spasm in a coronary artery. While Prinzmetal angina can sometimes lead to severe consequences (especially in smokers or people who abuse cocaine or amphetamines), it can usually be treated very successfully once the correct diagnosis is made.
