Prinzmetal's angina is rare, representing about two out of 100 cases of angina, and usually occurs in younger patients than those who have other kinds of angina. Causes of Variant (Prinzmetal) Angina: The pain from variant angina is caused by a spasm in the coronary arteries (which supply blood to the heart muscle)
Prinzmetal's angina typically responds to nitrates and calcium channel blockers.
Use of a beta blocker such as propranolol is contraindicated in Prinzmetal's angina.Prazosin has also been found to be of value in some patients.Coronary revascularization is only useful when the patient shows concomitant coronary atherosclerosis on coronary angiogram.
Signs and symptoms:
In contrast to patient with unstable angina secondary to coronary atherosclerosis, patients with variant angina are generally younger and have fewer coronary risk factors (except smoking). Episode of chest pain usually does not progress from a period of chronic stable angina. Cardiac examination is usually normal in the absence of ischemia.
Symptoms typically occur at rest, rather than on exertion (thus attacks usually occur at night).Two-thirds of patients have concurrent atherosclerosis of a major coronary artery, but this is often mild or not in proportion to the degree of symptoms.
Prinzmetal's should be suspected by a cardiologist when the pain occurs at rest and/or in clusters, and in the absence of a positive treadmill stress test, as Prinzmetal's is exercise tolerant and can generally only be diagnosed after other forms of cardiac disease have been ruled out.
It is associated with specific ECG changes (elevation rather than depression of the ST segment) together with small elevation of cardiac enzymes (especially with long attacks). However, in order to be diagnosed, these ECG changes can only be tracked when the electrocardiogram occurs while the patient is experiencing an attack. Therefore, many experts recommend provocative testing during electrocardiogram testing to attempt to induce an attack when Prinzmetal's is suspected.