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This is angina caused by focal spasm of angiographically normal coronary arteries.
In about 75% of patients there is also atherosclerotic coronary artery obstruction.
In cases where there is atherosclerotic obstruction the vasospasm occurs near
the stenotic lesion.
The chest pain may:
- occur at rest or wake
the patient from sleep
- be accompanied by dyspnoea and/or palpitations
be triggered by exertion; there is variability in the workload required to precipitate
The presumptive diagnosis of variant angina is made when the
patient has angina in association with transient ST-segment elevation, both of
which resolve spontaneously or with nitroglycerin (1)
- coronary arteriography
is recommended in all patients with Prinzmetal's angina (1)
- when coronary
arteriogram is normal or shows only nonobstructive plaques and if transient ST-segment
elevation can be demonstrated in association with discomfort, the diagnosis of
Prinzmetal's angina can be made and no further tests are necessary
The management of variant angina resembles that for other forms of angina. Nifedipine
and nitrates are particularly effective (2). Coronary stenting can be useful for
refractory spasm, CABG can be used for important coronary atherosclerosis (2).
patients with acute coronary syndromes in course of variant angina, adequate early
stent implantation may prevent acute myocardial infarction (3)
treated the prognosis is excellent and severe complications such as arrhythmias,
myocardial infarction or sudden death are rare (2).
VA can develop as a manifestation of a generalized vasospastic disorder associated
with attacks of migraine and Raynaud's phenomenon (4)
- patients with variant
angina are at the highest risk of cardiac death or acute myocardial infarction
during the early phase of the follow-up period, when disease activity is high
- during the first year of observation the patient must be followed
- in the great majority of patients there is a tendency for
symptoms to decrease; although in some patients may have periods of remission
and exacerbation of disease activity. Therefore, it has been recommended that
careful follow-up and medical therapy should not be discontinued in patients with
Prinzmetal's angina (1)
- DVLA guidance for Prinzmetal's angina
(variant angina) is as for angina per se (5)
W et al. Journal of Internal Medicine 2002;252 (4): 368-376.
P et al. Acta Cardiol 1999; 54 (2): 71-6.
- Sosnowski C et al. Coronary
artery stent placement as a treatment of acute coronary syndrome in course of
variant angina.International Journal of Cardiology, available online 6 April 2005.
BJ, Braunwald E, Rutherford JD. Prinzmetal's variant angina. In: Braunwald E (ed.).
Braunwald Heart Disease. WB Saunders Company, Philadelphia, 1997; 1340-3.
and Vehicle Licensing Agency. Report from Ischaemic Heart Disease Workshop – 6-7
Last reviewed 09/2019