Variant Angina (Prinzmetal's Angina)

Prinzmetal’s variant angina is caused by coronary artery
spasm of undetermined etiology. Pain usually occurs at
rest as opposed to typical stable angina occurring during
exertion. The ECG during pain shows ST-segment
elevation as opposed to typical angina showing ST-segment
depression. An ECG is not necessary, however, to initiate
therapy.
Beta-blockers can increase coronary artery spasm
and cause chest pain so they are contraindicated in
these patients. Management includes cessation of smoking,
avoidance of aspirin that may cause spasm, and
the use of high doses of nitroglycerin and calcium
antagonists.
Unfortunately patients with variant angina, even when
the syndrome is completely controlled by calcium
antagonists, have died or have had myocardial infarctions.
Although calcium antagonists are efficient in controlling
the pain of coronary artery spasm, they do not prevent
death. Coronary artery bypass surgery is indicated in
patients with significant atheromatous coronary artery
obstruction, which occurs coincidentally in some patients
with variant angina.

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