Coronary artery spasm (Prinzmetal’s angina) is a type of angina that occurs at rest. Also known as variant angina, it is brought on by a spasm in the coronary artery, causing temporary narrowing of the artery. This type of angina can occur both at rest and during activity. Although it can be relieved with medications, it can still be a very severe condition. On an electrocardiogram, variant angina appears with episodes of ST elevations.
Overall, angina is characterized by tightness in the chest and chest pain as a result 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 of the chest. For some, angina can be sudden, while in others it can be a chronic condition.
Aside from variant angina mentioned above, there are also stable angina and unstable angina. Stable angina is triggered by physical or emotional exertion. In unstable angina, plaque in the blood vessels either ruptures or forms a blood clot, reducing or blocking the blood flow very suddenly. Unstable angina is not relieved by your 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.
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 a long period of time, 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.
The most common causes of a coronary artery spasm are high cholesterol and high blood pressure. Nearly two percent of angina patients experience coronary artery spasm. Coronary artery spasms can also occur in patients with atherosclerosis (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 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 spasm, too, such as pain radiating from the chest to the neck, shoulders, or jaw, and pain that only occurs while at rest.
Aside from a physical examination, your doctor will run other tests to better diagnose variant angina. These tests include blood tests to check for cardiac biomarkers (troponin) and enzymes creatine kinase (CK) that leak from the damaged heart muscle, electrocardiogram to see patterns in your heartbeats indicating reduced blood flow, echocardiography to produce images of your heart to check for angina-related problems, stress tests to cause your heart to work harder and make angina easier to detect, computed tomography angiography, as well as coronary angiography and heart catheterization to study the state of health and caliber of your arteries.
The main target of coronary artery spasm treatment is pain relief, which can be done through different medications including nitrates and calcium channel blockers. Your doctor may put you on medications to reduce your risk factors for variant angina, including medications for high blood pressure and cholesterol.
Additionally, your doctor will recommend you adhere to a healthy lifestyle involving healthy eating, exercising regularly, losing weight, not smoking, reducing your intake of alcohol, and reducing stress.