Variant Angina: Heart Spasms

Whenever most people think of chest pain, they associate it with a 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.

What is Variant 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 as 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 CAD disease in at least one 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.

What are the Symptoms of Variant Angina?

The symptoms of variant angina include:

• Intermittent chest pain that:
  • Occurs while resting, or during the overnight or early morning hours
  • May spread to other parts of the body, such as the throat, arms, between the shoulder blades, or stomach (may feel like an ulcer or indigestion)
  • Gives a feeling of tightness, pressure, or heaviness
• Nausea
• Sweating
• Palpitations—rapid, irregular, or skipped heartbeats
• Lightheadedness
• Trouble breathing

How Is Variant Angina Diagnosed?

Variant angina is rare, so you may undergo standard heart tests to determine what is causing your chest pains. Diagnostic tests may help pinpoint a problem, but they can also be used to rule out other conditions. Tests may include:

• ECG—To record the electrical activity of your heart. If done during an attack, it may show changes due to low blood flow to the heart. This test may also identify heart rhythm problems and damage to your heart caused by a previous heart attack.
• Blood tests—To look for cholesterol, blood glucose, and inflammatory marker levels. Testing for the presence/quantity of heart muscle enzymes in the blood may indicate heart muscle damage.
• Holter monitor—Records your heart's electrical activity for up to 72 hours.
• Stress test—To evaluate heart function during exercise.

If necessary, your doctor will recommend imaging tests that can better evaluate the structure and function of the heart and blood vessels.

How Is Variant Angina Treated?

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 also includes:

• Stopping the use of any drugs that cause coronary artery spasm
• Reviewing your lifestyle and habits to reduce your risk for heart disease, such as eating a heart-healthy diet and regular physical activity
• Having frequent follow-up appointments to check your progress
• Quitting smoking

What Can You Do?

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 may be no way for you 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:

• Follow your treatment plan, which may include medications and lifestyle changes
• Avoiding drugs that may worsen your condition
• Reporting any new symptoms to your doctor right away
• Learning how anxiety and stress affect you and develop methods to help you cope more effectively

Revision Information

• Reviewer: EBSCO Medical Review Board Michael Woods, MD, FAAP
• Review Date: 10/2017
• Update Date: 01/29/2014