Prinzmetal's variant angina

Prinzmetal's Variant Angina

Prinzmetal's variant angina, also known as vasospastic angina, is a type of angina pectoris (chest pain) caused by a spasm in the coronary arteries. This condition is distinct from the more common forms of angina, which are typically due to atherosclerosis, or the buildup of plaque in the coronary arteries.

Pathophysiology

Prinzmetal's variant angina occurs when a coronary artery spasm temporarily reduces blood flow to the heart muscle, leading to chest pain. Unlike stable angina, which is often triggered by physical exertion or stress, variant angina can occur at rest, often in cycles. The exact mechanism of the coronary artery spasm is not fully understood, but it is believed to involve hyperactivity of the smooth muscle in the arterial wall, possibly influenced by endothelial dysfunction or autonomic nervous system imbalances.

Symptoms

The primary symptom of Prinzmetal's variant angina is chest pain, which can be severe and is often described as a squeezing or pressure-like sensation. The pain typically occurs at rest, often during the night or early morning hours. It may be accompanied by other symptoms such as:

• Palpitations
• Shortness of breath
• Sweating
• Nausea

Diagnosis

Diagnosis of Prinzmetal's variant angina is based on clinical presentation and diagnostic testing. Key diagnostic tools include:

• Electrocardiogram (ECG): During an episode of chest pain, the ECG may show transient ST-segment elevation, which resolves after the pain subsides.
• Coronary Angiography: This imaging test can help rule out significant atherosclerotic disease and may show the spasm if it occurs during the procedure.
• Provocative Testing: Agents such as ergonovine or acetylcholine may be used during angiography to provoke a spasm and confirm the diagnosis.

Treatment

The management of Prinzmetal's variant angina focuses on relieving symptoms and preventing future episodes. Treatment options include:

• Calcium Channel Blockers: These medications, such as diltiazem or amlodipine, help prevent coronary artery spasms.
• Nitrates: Both short-acting and long-acting nitrates can be used to relieve and prevent angina attacks.
• Lifestyle Modifications: Patients are advised to avoid smoking and manage stress, as these can trigger spasms.

Prognosis

With appropriate treatment, the prognosis for patients with Prinzmetal's variant angina is generally good. However, if left untreated, the condition can lead to complications such as myocardial infarction or arrhythmias.

Also see

• Angina Pectoris
• Coronary Artery Disease
• Myocardial Infarction
• Electrocardiogram

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