Vasospastic/variant angina (Prinzmetal’s angina)

Vasospastic/variant angina (Prinzmetal’s angina)

Vasospastic/variant angina is characterized by pain at rest and occasionally on exertion, associated with ST elevation in ECG during the pain. The important differential diagnosis is ST elevation myocardial infarction. It is difficult to make a prospective differential diagnosis from ST elevation myocardial infarction as soon as the patient presents as the other criteria of myocardial infarction like elevation of cardiac Troponins will take some time to occur. The angina in Prinzmetal’s angina is relieved within minutes by nitrates. The pain may co-exist with typical effort angina which is due to associated fixed coronary lesions.

Fixed obstruction may be seen in as many as two thirds of patients with vasospastic angina. When there is fixed obstruction, prognosis is poorer, while those without fixed obstruction have a self limited course and good prognosis. Vasospasm may occur in response to smoking, cocaine use, cold stimulation or hyperventilation. Ambulatory ST segment monitoring may be useful in documenting episodes of Prinzmetal’s angina.