Variant/Prinzmetal’s angina - Ischaemic heart disease

Variant/Prinzmetal’s angina

Definition

Angina of no obvious provocation not as a direct result of atheroma.

Aetiology/pathophysiology

Caused by spasm of a coronary artery most often without atheroma or in association with a mild eccentric lesion. The reason for spasm occurring is unknown.

Clinical features

Pain is usually more severe and more prolonged than classical angina occurring at rest particularly in the early morning.

Complications

Arrhythmias may occur in the ischaemic episode (usually heart block and ventricular tachycardia), and very rarely the ischaemia may result in myocardial infarction.

Investigations

ECG shows characteristic ST elevation during an attack.

Management

Nitrates and calcium antagonists are useful as prophylaxis and as acute treatment. Î²-blockers tend to increase coronary tone and hence exacerbate the angina. It may be necessary to treat the arrhythmias provoked by the spasm.

Surgical treatment is rarely necessary or possible.

Prognosis

The prognosis in patients with angina without underlying heart or metabolic disease is very good.