Coronary artery spasm (Prinzmetal’s angina) is a type of angina that occurs at rest. It’s brought on by a spasm in the coronary artery, causing temporary narrowing of the artery. Although it can be relieved with medications, it is still a very severe condition. On an electrocardiogram, Prinzmetal’s angina—also called variant angina—appears with episodes of ST elevations.
Angina is characterized by tightness in the chest and chest pain because of reduced blood flow to the heart. Angina is not a disease on its own, but rather a symptom of coronary artery disease. Patients may experience tightness, pain, squeezing, pressure, or heaviness in the chest. For some, angina can be sudden, while in others, it can be a chronic condition.
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Aside from variant angina, there is also stable angina and unstable angina. Stable angina is triggered by physical or emotional exertion. In unstable angina, plaque in the blood vessels ruptures or forms a blood clot, reducing or blocking blood flow. Unstable angina is not relieved by common medications, rather, it requires emergency treatment.
It’s important that angina is properly diagnosed and well managed to reduce the risk of complications and death.
What is Prinzmetal’s angina?
A coronary artery spasm is a temporary constriction of the muscles in the artery walls. When this occurs, blood flow becomes restricted, resulting in symptoms. A coronary artery spasm can decrease the amount of blood flowing through the artery or blocking the passageway altogether.
If a coronary artery spasm lasts for an extended period, it can result in angina or even a heart attack. Unlike stable angina, which is triggered by physical exertion, variant angina occurs while at rest, usually between the hours of midnight and early morning.
Prevalence of variant angina
The prevalence of variant angina varies considerably depending on geographic location of the population studied as well as the criteria used to test and diagnose the condition. In the United States, it is estimated that about four percent of patients who undergo coronary angiography show evidence of focal spasm, which may be interpreted as variant angina.
The average age can also be highly variable but it is thought to occur more frequently in patients in their 50s. Females are believed to be more frequently diagnosed with variant angina, however, some studies have linked the condition to be more common in men.
Causes, risk factors, and complications of variant angina
The most common causes of coronary artery spasm are high cholesterol and high blood pressure. Nearly two percent of angina patients experience coronary artery spasm daily. Coronary artery spasms can also occur in patients with atherosclerosis, which is a condition characterized by narrowing of the arteries due to plaque buildup and resulting blood flow reduction.
Risk factors for coronary artery spasm include high blood pressure, high cholesterol, atherosclerosis, smoking, excess use of stimulants like illicit drugs, extreme stress, extreme cold, and alcohol withdrawal.
Although episodes of coronary artery spasm may be brief, they can lead to future health complications. If variant angina is left untreated, it can contribute to heart arrhythmias, heart attacks, cardiac arrest, and even death.
Symptoms of Prinzmetal’s angina
Symptoms of Prinzmetal’s angina include chest pain varying in severity, pain in the left side of your chest, chest tightness, and a feeling of constriction in the chest. Other symptoms may accompany coronary artery spasms, such as pain radiating from the chest to the neck, shoulders, or jaw, and pain that only occurs while at rest.
Diagnosing variant angina
The diagnosis of variant angina can be quite complicated as the cause of the condition may have already occurred. This leaves physicians with only symptoms left behind to base their diagnosis off of. It is estimated that between two to ten percent of angina patients suffer from variant angina, but the distinction is often overlooked by a cardiologist who stops testing protocol once a ruling of typical angina has been found.
Regardless of this fact, a complete physical examination, complete with a patient’s history of presenting symptoms, will be taken. Additionally, the use of computed tomography (CT) or magnetic resonance imaging (MRI) angiography may be utilized to help observe blood flow through the affected blood vessel. Other tests that may be used include a transcranial doppler ultrasound, to measure blood flow throughout the arteries of the base of the brain, as well as ambulatory and exercise electrocardiogram (ECG), to evaluate the electrical activity of the heart. More invasive tests may be used, namely coronary angiography and provocative coronary spasm testing.
Prinzmetal’s angina treatment and prevention
Pain relief is the target of coronary artery spasm treatment. Your doctor may put you on medications to reduce your risk of variant angina, including medications for high blood pressure.
Additionally, your doctor will recommend you adhere to a healthy lifestyle that involves healthy eating, exercising regularly, losing weight, not smoking, reducing your intake of alcohol, and reducing stress.
Prinzmetal’s angina home treatment
An experienced doctor should treat Prinzmetal’s angina because it’s a very serious condition. However, there are actions you can take to help manage the symptoms.
- Avoid smoking: Smoking can cause the blood vessels in the body to constrict, leading to decreased blood flow. Smoking also promotes the build-up of plaque in the arteries that can complicate Prizmetal’s angina.
- Manage stress levels: Stress leads to blood vessel constriction and possible worsening of Prinzmetal’s angina symptoms.
- Avoid hyperventilation: Breathing too hard and for extended periods of time can be a trigger for symptoms.
- Eat a healthy diet: Avoid meals high in saturated fats and choose sources of unsaturated fat such as olive or canola oil. Fish is also a good substitute for red meat. It is a good idea to avoid excessive consumption of refined carbohydrates. Healthy diets have decent servings of fresh fruit and dark green leafy vegetables.
- Avoid severe cold: It is a clever idea to stay where it’s warm, as cold weather can create challenges for the cardiovascular system by constricting blood vessels.
- Know your danger time zones: According to a study, Prinzmetal’s angina and several other cardiac conditions have a circadian rhythm and may follow a “24 hour” pattern, meaning they are more likely to occur at certain times.
- Consider yoga or relaxation therapy: This is a fantastic way to lower stress, which can help reduce hyperactivity of the circulatory system.
Prognosis of variant angina
Patients with variant angina often have three-to-six-month clusters of recurrent attacks that are usually separated by relative symptom-free periods. As more time passes, symptoms tend to gradually reduce but may still present themselves from time to time. Long-term survival of variant angina patients tends to be good, especially those who adhere to treatment and avoid smoking. Those with preexisting coronary atherosclerosis, who continue to smoke, are intolerant to calcium antagonists, and have spasms of multiple coronary arteries are predicted to have poorer outcomes.
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The Japanese Coronary Spasm Association (JCSA) derived the “JCSA risk score” to guide predictions for patients with coronary vasospasm. Criteria for this risk score includes:
- History of out-of-hospital cardiac arrest (four points)
- Smoking, angina at rest alone, organic coronary stenosis, multi-vessel spasm (two points each)
- Beta-blocker use, ST elevation during angina (one point each)
Patients are scored to estimate their risk of major adverse cardiac events (MACE). Previous studies have should that patients with a low score of zero to two had a MACE of 2.5 percent, an intermediate score of three to five had a MACE of seven percent, and those whose scores six or higher had a MACE of 13%.
Any case of variant angina should not be ignored as it can be difficult to say for sure that it is due to serious or non-serious causes. However, using your better judgment and recognizing that your particular cause is not normal will be the first step in recovery.
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