Variant angina is a type of chest pain that originates from the heart. Unlike stable angina, which is brought on by physical exertion, variant angina attacks occur when a person is at rest or asleep. Also known as Prinzmetal’s angina or vasospastic angina, it is defined by a temporary spasm in the coronary arteries, which supply blood to the heart muscle. This spasm causes a sudden narrowing of the artery, restricting blood flow.
While it can affect anyone, it often appears in younger individuals than those with classic angina. The pain is not caused by permanent blockages, although underlying coronary artery disease can be present. The experience is often described as a squeezing, pressure, or tightness in the chest.
Underlying Causes and Triggers
The cause of variant angina is a sudden, temporary tightening of the smooth muscle within a coronary artery’s walls. This event, known as a vasospasm, constricts the vessel and causes the hyper-reactive response that leads to intermittent spasms. Several factors are known to provoke these coronary spasms, including:
- Smoking
- Exposure to cold temperatures
- Emotional stress or hyperventilation
- Recreational drugs like cocaine and amphetamines
Certain medications that constrict blood vessels, such as the migraine drug sumatriptan or stimulants like ephedrine, can also induce a spasm. In some cases, manipulation of the coronary arteries during medical procedures or an underlying metabolic disorder like insulin resistance can be associated with the condition.
Recognizing Symptoms and Diagnostic Process
The primary symptom is severe chest pain that occurs at rest. Episodes frequently happen in a cyclical pattern, often between midnight and the early morning hours. The pain can last from five to fifteen minutes and is relieved by fast-acting nitrates.
An electrocardiogram (ECG) is a primary diagnostic tool. During an episode, the ECG can show specific transient changes, such as ST-segment elevation, that return to normal once symptoms resolve. Because episodes can be sporadic, a doctor may recommend ambulatory monitoring with a Holter monitor to record the heart’s electrical activity over time.
To confirm the diagnosis, a coronary angiography is often performed. This procedure uses a special dye and X-rays to visualize blood flow. A physician may conduct provocative testing during the angiography, where a substance is administered to safely induce a spasm for direct observation. A positive test involves a significant, reversible constriction of the artery.
Treatment and Management Strategies
Treatment focuses on preventing spasms and relieving symptoms. The primary medications are long-acting nitrates and calcium channel blockers, which relax and dilate the coronary arteries to prevent vasospasms. Calcium channel blockers are effective in alleviating symptoms for a majority of patients.
To manage the timing of episodes, these long-acting medications are often prescribed to be taken at night. For immediate relief of an acute episode, sublingual glyceryl trinitrate (GTN) is used as a tablet or spray. This medication works quickly to relieve the chest pain caused by a spasm.
Certain drugs, such as non-selective beta-blockers, should be avoided as they can worsen spasms. Lifestyle modifications are also part of the management plan, and quitting smoking is the most important change for individuals who smoke.
Prognosis and Potential Complications
For most individuals who receive an accurate diagnosis and adhere to their treatment plan, the long-term outlook is very good. Variant angina is a chronic condition requiring ongoing management with medication and lifestyle adjustments. Consistent use of prescribed medications is effective in controlling symptoms and preventing spasms.
While the condition is manageable, untreated variant angina can lead to serious complications. A prolonged or severe spasm can cause a lack of blood flow (ischemia), potentially resulting in a heart attack.
In some instances, spasms can trigger dangerous arrhythmias (irregular heartbeats) that may lead to fainting or cardiac arrest. Following the prescribed treatment regimen is fundamental to preventing these outcomes.