Whenever we think chest pain, we think heart attack. That’s important because any type of chest pain is a serious warning and should be evaluated by emergency medical services right away. However, there is a chance it could turn out be a rare form of angina called variant or Prinzmetal's angina.
Variant angina is caused by a spasm in a coronary artery that supplies the heart muscle with blood, oxygen, and nutrients. A spasm is a sudden, temporary narrowing or tightening of a small part of an artery. This spasm results in a temporary situation where the heart does not get enough blood. The blockage of blood flow causes the characteristic chest pain associated with angina.
Unlike other forms of angina, variant angina occurs during periods of rest, when you are not exerting yourself. Generally this occurs during the overnight or early morning hours.
Coronary artery spasms can occur in people who do not have significant coronary artery disease (CAD). CAD occurs a result of atherosclerosis, a narrowing and hardening of the coronary arteries caused by plaque deposits lining artery walls. However, some people with variant angina have severe disease in at least 1 blood vessel. The spasm typically occurs at the site of blockage. Fortunately, coronary artery spasm does not typically trigger the series of events that can lead to a heart attack. However, if a coronary artery spasm is severe and occurs for a long period of time, a heart attack can occur.
Coronary artery spasm may be triggered by emotional stress, exposure to cold, cocaine use, or heavy smoking. People who have underlying coronary artery disease, hypertrophic cardiomyopathy (an enlarged heart due to disease), disease of the heart valves, or uncontrolled high blood pressure are also at an increased risk of variant angina.
The symptoms of variant angina include:
Variant angina is rare, so you may undergo standard heart tests to determine what is causing your chest pains. Diagnostic tests help pinpoint a problem, but they can also be used to rule out other conditions. Tests may include:
If necessary, your doctor will recommend imaging tests that can better evaluate the structure and function of the heart and blood vessels.
Variant angina is often treated with medications called calcium channel blockers. These medications can decrease variant angina attacks and are often used in combination with nitrates during attacks. If another condition is contributing to your angina, such as CAD, then it will need to be treated as well..
The goal of treating variant angina is to stop the symptoms. Your doctor will work with you to come up with a plan that includes:
Remember that many types of chest pain aren’t related to angina at all. For example, heartburn, injury, or inflammation of the lungs may also cause chest pain. However, there is no way for you, especially if you are at home and frightened, to distinguish one type of chest pain from another. Therefore, any chest pain you experience should be evaluated by emergency medical services right away. It is important to note that you should not drive to the hospital. Emergency medical services begin life-saving treatment on the way to the hospital, which could save your life if you are having a heart attack.
However, if you have a history of variant angina, there are some things you can do to take care of yourself, such as:
American Heart Association
Office on Women's Health
Canadian Cardiovascular Society
Heart and Stroke Foundation of Canada
Acute coronary syndromes. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated October 29, 2015. Accessed November 11, 2015.
Coronary artery disease (CAD). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated August 26, 2015. Accessed November 11, 2015.
Kusama Y, Kodani E, et al. Variant angina and coronary artery spasm: the clinical spectrum, pathophysiology, and management. J Nippon Med Sch. 2011;78(1):4-12.
Prinzmetal angina, variant angina, and angina inversa. American Heart Association website. Available at: http://www.heart.org/HEARTORG/Conditions/HeartAttack/SymptomsDiagnosisofHeartAttack/Prinzmetals-or-Prinzmetal-Angina-Variant-Angina-and-Angina-Inversa_UCM_435674_Article.jsp#.VkOW3b8TDOs. Updated March 19, 2013. Accessed November 11, 2015.
Last reviewed October 2015 by Michael Woods, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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