Variant angina

Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
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Variant angina
Synonyms	Prinzmetal angina, angina inversa
Pronounce	N/A
Specialty	N/A
Symptoms	Chest pain, palpitations, shortness of breath
Complications	Myocardial infarction, arrhythmia
Onset	Typically occurs at rest, often at night
Duration	Episodes last from 5 to 30 minutes
Types	N/A
Causes	Coronary artery spasm
Risks	Smoking, hyperlipidemia, hypertension, stress
Diagnosis	Electrocardiogram, coronary angiography
Differential diagnosis	Stable angina, unstable angina, myocardial infarction
Prevention	Avoidance of triggers, smoking cessation, stress management
Treatment	Calcium channel blockers, nitrates
Medication	Diltiazem, verapamil, nitroglycerin
Prognosis	Generally good with treatment
Frequency	Rare, more common in Japan and among smokers
Deaths	N/A

Diagram illustrating the mechanism of variant angina.

Variant angina, also known as Prinzmetal's angina, is a type of angina pectoris characterized by chest pain due to coronary artery spasm. Unlike typical angina, which is often triggered by physical exertion or stress, variant angina usually occurs at rest, often in cycles.

Pathophysiology

Variant angina is caused by a temporary reduction in blood flow to the myocardium due to spasms in the coronary arteries. These spasms can occur in normal or atherosclerotic arteries and lead to ischemia and chest pain. The exact mechanism of the spasm is not fully understood, but it is believed to involve endothelial dysfunction and increased smooth muscle reactivity.

Symptoms

The primary symptom of variant angina is chest pain, which can be severe and is often described as a squeezing or pressure 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, sweating, and shortness of breath.

Diagnosis

Diagnosis of variant angina is based on the clinical presentation and can be confirmed with electrocardiogram (ECG) changes during an episode of pain. The ECG may show ST segment elevation during the spasm, which resolves when the spasm subsides. Coronary angiography can be used to visualize the coronary arteries and confirm the presence of spasms.

Treatment

The treatment of variant angina focuses on relieving symptoms and preventing future episodes. Calcium channel blockers and nitrates are the mainstays of treatment, as they help to prevent coronary artery spasms. Lifestyle modifications, such as avoiding smoking and stress, are also recommended.

Prognosis

With appropriate treatment, the prognosis for individuals with variant angina is generally good. However, if left untreated, it can lead to serious complications such as myocardial infarction or arrhythmias.

See also

• Angina pectoris
• Coronary artery disease
• Myocardial infarction
• Electrocardiogram