Alternate Names: Variant angina; Angina - variant

Causes and Risks:

Coronary artery spasm is a cause of ischemia (inadequate oxygen levels) of the heart. It affects approximately 4 out of 100,000 people, or 2% of patients with angina.

The arteries affected may be normal or, much more often, they are "hardened" (atherosclerotic). Spasm may be "silent" – without symptoms – or it may result in stable angina or unstable angina. The most typical manifestation is variant angina (see below). Prolonged spasm may even cause heart attack.

Coronary artery spasm may occur spontaneously, or it may be caused by exposure to cold, emotional stress, alcohol withdrawal, or vasoconstricting medications. Cocaine use and cigarette smoking can cause severe spasm of the arteries while at the same time increasing the energy requirements of the heart. Variant angina is a syndrome, probably involving coronary artery spasm, where the angina pain is triggered by rather unusual factors. It most often affects women under 50, but also men.

Prevention: Prevention can be directed against progression of coronary atherosclerosis and against known angina triggers. Low fat diet and increased exercise may reduce the risk of atherosclerosis. Exposure to cold, cocaine use, cigarette smoking, and stress should be avoided.

Symptoms: The main symptom is angina (a type of Chest pain), with these characteristics:

• Under the sternum
• Described as squeezing, constricting, tightness, pressure, crushing; it is usually severe may radiate to the neck, jaw, shoulder, arm
• It often occurs at rest
• May occur at the same time each day, usually between midnight and 8:00 AM
• Pain lasts from 5 to 30 minutes
• Pain is relieved by nitroglycerin – sublingual
• Syncope (loss of consciousness) often accompanies the angina

Signs and Tests:

An examination is usually inconclusive, but may indicate atherosclerosis. A coronary angiography shows spasms when the artery is injected with ergonovine, and may show fixed lesions such as clot or atherosclerosis, which contribute to chest pain.

An ECG may show ischemic changes during chest pain, and it may show arrhythmias or conduction defects.

Treatment:

The goal of treatment is to control chest pain and to prevent heart attack. Nitroglycerin or other nitrate medications may be prescribed to relieve chest pain. Calcium-channel blockers may be chronically needed.

Medications may also include beta-blockers. However, in some cases of variant angina, beta-blockers may be detrimental.

Prognosis: Coronary artery spasm is a chronic condition. Symptoms usually respond to treatment. This disorder may indicate a high risk for acute MI or serious arrythmias.

Complications:

• Acute MI
• Fatal arrhythmias

Call your health care provider if crushing or heavy chest pain occurs, or if chest pain does not respond to nitroglycerin in people with a prior history of angina.