Prinzmetal angina, also known as variant angina or vasospastic angina, is a type of chest pain or angina pectoris that occurs due to transient spasms or narrowing of the coronary arteries. This condition was first described by Dr. Myron Prinzmetal in 1959.
Prinz-Metal angina attacks can be triggered by various factors, such as exposure to cold weather, emotional stress, smoking, and certain medications. The symptoms of Prinz-Metal angina can be similar to those of stable angina and may include chest pain or discomfort, shortness of breath, and a feeling of pressure or squeezing in the chest.
Epidemiology
Prinzmetal angina is less common than other forms, such as stable or unstable angina. Its prevalence varies among different populations and regions. It is estimated to account for approximately 2-3% of all cases of angina. Prinzmetal angina tends to occur in relatively younger individuals compared to other forms of angina, often between the ages of 40 and 70.
It has been observed that men are more commonly affected than women, with a male-to-female ratio of around 3:1. The prevalence of Prinzmetal angina may vary by geographic location. It has been reported to be more common in certain regions, such as Japan, where it is sometimes called “Japanese variant angina.” Genetic and environmental factors may contribute to these regional differences.
Anatomy
Pathophysiology
The development of coronary artery spasms involves a complex interplay of factors. One potential mechanism leading to spasms is an increased sensitivity of the blood vessels to constricting stimuli, narrowing coronary arteries either in a localized area or diffusely throughout the coronary circulation. This narrowing can lead to reduced coronary blood flow, creating a state of myocardial ischemia or oxygen deprivation in the heart muscle.
The exact cause of this increased reactivity of coronary vessels remains uncertain. However, it may be linked to dysfunction in the endothelial lining of the arteries and potential impairments in the regulatory mechanisms controlling vessel constriction and dilation within the smooth muscle cells of the coronary vessels.
Maintaining a delicate balance between the sympathetic and parasympathetic nervous systems is crucial in regulating coronary blood flow. An imbalance in this system can predispose the coronary arteries to excessive constriction even under normal conditions and can further exacerbate spasms when exposed to substances like acetylcholine and methacholine.
Etiology
Prinzmetal angina can occur due to either diffuse or segmental spasms in the coronary arteries, which reduces blood supply to the heart muscle and results in symptoms such as chest pain.
These spasms can be triggered by various factors, including exposure to cold weather, physical exertion or exercise, or the ingestion of substances that promote blood vessel constriction, such as alpha-agonists like oxymetazoline and pseudoephedrine.
Recreational drug use, particularly the use of cocaine, has been associated with the development of vasospastic angina, especially when used in conjunction with cigarette smoking. This combination of factors can further increase the risk of coronary artery spasms and the associated chest pain symptoms.
Genetics
Prognostic Factors
Clinical History
The hallmark symptom of Prinzmetal angina is chest pain. It can occur at rest and may wake the patient from sleep. The pain typically lasts for several minutes and can be severe. The pain may radiate to other upper body areas, including the left arm, shoulder, jaw, or neck. Patients with Prinzmetal angina may experience symptoms such as shortness of breath, palpitations, and a sense of impending doom.
Prinzmetal angina typically occurs at rest or during periods of reduced physical activity. It can also happen during sleep, waking the patient from their slumber due to the pain. Episodes of Prinzmetal angina typically last for several minutes but can persist for longer periods. The duration of the chest pain can vary from one episode to another. It is also characterized by recurrent, intermittent episodes of chest pain, with variable intervals of symptom-free periods between episodes.
Physical Examination
The patient may experience or report chest discomfort or pain during the examination. This pain is typically described as tightness, squeezing, or pressure in the chest. During an episode of Prinzmetal angina, blood pressure may temporarily increase due to the stress and pain associated with the condition. The heart rate may be assessed, and any irregularities or changes may be noted.
Tachycardia can occur as a response to chest pain and stress. In some cases, a patient’s skin may become pale or sweaty during an episode of chest pain or discomfort. These signs may be related to the body’s response to pain and stress. It’s important to emphasize that Prinzmetal angina is primarily a vasospastic disorder affecting the coronary arteries, and physical examination findings may be normal or inconclusive during symptom-free periods.
Age group
Associated comorbidity
Associated activity
Acuity of presentation
Differential Diagnoses
Angina Pectoris
Anxiety Disorder
Cocaine Toxicity
Esophageal Spasms
Myocardial Infarction
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
Calcium antagonists play a crucial role in managing vasospastic angina and are considered a first-line treatment due to their ability to induce vasodilation in the coronary vasculature. They effectively relieve symptoms in approximately 90% of patients with this condition. Additionally, research has shown that calcium channel blocker therapy independently predicts better myocardial infarct-free survival in individuals with vasospastic angina.
To optimize the effectiveness of calcium antagonists in managing vasospastic angina, it is recommended to use a long-acting formulation, particularly at night, as episodes of vasospasm are more frequent during the midnight and early morning hours. High doses of long-acting calcium antagonists such as amlodipine, diltiazem, nifedipine, or verapamil are typically prescribed.
The titration of the medication should be tailored to each patient, aiming for an adequate response while minimizing side effects. In cases where an individual does not respond well to a single calcium antagonist, a combination therapy approach using two different types of calcium antagonists, specifically dihydropyridine and non-dihydropyridine agents, can be considered. This combination therapy may be more effective in patients with a poor response to a single agent.
Lifestyle Modifications
The primary aim of treatment for vasospastic angina is to reduce the frequency of angina episodes and prevent potential complications such as myocardial injury and arrhythmias. Encouraging lifestyle modifications is crucial, with a particular emphasis on smoking cessation. This intervention is a critical component in reducing the occurrence of angina episodes.
Prinzmetal angina, also known as variant angina or vasospastic angina, is a type of chest pain or angina pectoris that occurs due to transient spasms or narrowing of the coronary arteries. This condition was first described by Dr. Myron Prinzmetal in 1959.
Prinz-Metal angina attacks can be triggered by various factors, such as exposure to cold weather, emotional stress, smoking, and certain medications. The symptoms of Prinz-Metal angina can be similar to those of stable angina and may include chest pain or discomfort, shortness of breath, and a feeling of pressure or squeezing in the chest.
Prinzmetal angina is less common than other forms, such as stable or unstable angina. Its prevalence varies among different populations and regions. It is estimated to account for approximately 2-3% of all cases of angina. Prinzmetal angina tends to occur in relatively younger individuals compared to other forms of angina, often between the ages of 40 and 70.
It has been observed that men are more commonly affected than women, with a male-to-female ratio of around 3:1. The prevalence of Prinzmetal angina may vary by geographic location. It has been reported to be more common in certain regions, such as Japan, where it is sometimes called “Japanese variant angina.” Genetic and environmental factors may contribute to these regional differences.
The development of coronary artery spasms involves a complex interplay of factors. One potential mechanism leading to spasms is an increased sensitivity of the blood vessels to constricting stimuli, narrowing coronary arteries either in a localized area or diffusely throughout the coronary circulation. This narrowing can lead to reduced coronary blood flow, creating a state of myocardial ischemia or oxygen deprivation in the heart muscle.
The exact cause of this increased reactivity of coronary vessels remains uncertain. However, it may be linked to dysfunction in the endothelial lining of the arteries and potential impairments in the regulatory mechanisms controlling vessel constriction and dilation within the smooth muscle cells of the coronary vessels.
Maintaining a delicate balance between the sympathetic and parasympathetic nervous systems is crucial in regulating coronary blood flow. An imbalance in this system can predispose the coronary arteries to excessive constriction even under normal conditions and can further exacerbate spasms when exposed to substances like acetylcholine and methacholine.
Prinzmetal angina can occur due to either diffuse or segmental spasms in the coronary arteries, which reduces blood supply to the heart muscle and results in symptoms such as chest pain.
These spasms can be triggered by various factors, including exposure to cold weather, physical exertion or exercise, or the ingestion of substances that promote blood vessel constriction, such as alpha-agonists like oxymetazoline and pseudoephedrine.
Recreational drug use, particularly the use of cocaine, has been associated with the development of vasospastic angina, especially when used in conjunction with cigarette smoking. This combination of factors can further increase the risk of coronary artery spasms and the associated chest pain symptoms.
The hallmark symptom of Prinzmetal angina is chest pain. It can occur at rest and may wake the patient from sleep. The pain typically lasts for several minutes and can be severe. The pain may radiate to other upper body areas, including the left arm, shoulder, jaw, or neck. Patients with Prinzmetal angina may experience symptoms such as shortness of breath, palpitations, and a sense of impending doom.
Prinzmetal angina typically occurs at rest or during periods of reduced physical activity. It can also happen during sleep, waking the patient from their slumber due to the pain. Episodes of Prinzmetal angina typically last for several minutes but can persist for longer periods. The duration of the chest pain can vary from one episode to another. It is also characterized by recurrent, intermittent episodes of chest pain, with variable intervals of symptom-free periods between episodes.
The patient may experience or report chest discomfort or pain during the examination. This pain is typically described as tightness, squeezing, or pressure in the chest. During an episode of Prinzmetal angina, blood pressure may temporarily increase due to the stress and pain associated with the condition. The heart rate may be assessed, and any irregularities or changes may be noted.
Tachycardia can occur as a response to chest pain and stress. In some cases, a patient’s skin may become pale or sweaty during an episode of chest pain or discomfort. These signs may be related to the body’s response to pain and stress. It’s important to emphasize that Prinzmetal angina is primarily a vasospastic disorder affecting the coronary arteries, and physical examination findings may be normal or inconclusive during symptom-free periods.
Angina Pectoris
Anxiety Disorder
Cocaine Toxicity
Esophageal Spasms
Myocardial Infarction
Calcium antagonists play a crucial role in managing vasospastic angina and are considered a first-line treatment due to their ability to induce vasodilation in the coronary vasculature. They effectively relieve symptoms in approximately 90% of patients with this condition. Additionally, research has shown that calcium channel blocker therapy independently predicts better myocardial infarct-free survival in individuals with vasospastic angina.
To optimize the effectiveness of calcium antagonists in managing vasospastic angina, it is recommended to use a long-acting formulation, particularly at night, as episodes of vasospasm are more frequent during the midnight and early morning hours. High doses of long-acting calcium antagonists such as amlodipine, diltiazem, nifedipine, or verapamil are typically prescribed.
The titration of the medication should be tailored to each patient, aiming for an adequate response while minimizing side effects. In cases where an individual does not respond well to a single calcium antagonist, a combination therapy approach using two different types of calcium antagonists, specifically dihydropyridine and non-dihydropyridine agents, can be considered. This combination therapy may be more effective in patients with a poor response to a single agent.
Lifestyle Modifications
The primary aim of treatment for vasospastic angina is to reduce the frequency of angina episodes and prevent potential complications such as myocardial injury and arrhythmias. Encouraging lifestyle modifications is crucial, with a particular emphasis on smoking cessation. This intervention is a critical component in reducing the occurrence of angina episodes.
medtigo
Prinzmetal Angina
Updated :
September 8, 2023
Prinzmetal angina, also known as variant angina or vasospastic angina, is a type of chest pain or angina pectoris that occurs due to transient spasms or narrowing of the coronary arteries. This condition was first described by Dr. Myron Prinzmetal in 1959.
Prinz-Metal angina attacks can be triggered by various factors, such as exposure to cold weather, emotional stress, smoking, and certain medications. The symptoms of Prinz-Metal angina can be similar to those of stable angina and may include chest pain or discomfort, shortness of breath, and a feeling of pressure or squeezing in the chest.
Prinzmetal angina is less common than other forms, such as stable or unstable angina. Its prevalence varies among different populations and regions. It is estimated to account for approximately 2-3% of all cases of angina. Prinzmetal angina tends to occur in relatively younger individuals compared to other forms of angina, often between the ages of 40 and 70.
It has been observed that men are more commonly affected than women, with a male-to-female ratio of around 3:1. The prevalence of Prinzmetal angina may vary by geographic location. It has been reported to be more common in certain regions, such as Japan, where it is sometimes called “Japanese variant angina.” Genetic and environmental factors may contribute to these regional differences.
The development of coronary artery spasms involves a complex interplay of factors. One potential mechanism leading to spasms is an increased sensitivity of the blood vessels to constricting stimuli, narrowing coronary arteries either in a localized area or diffusely throughout the coronary circulation. This narrowing can lead to reduced coronary blood flow, creating a state of myocardial ischemia or oxygen deprivation in the heart muscle.
The exact cause of this increased reactivity of coronary vessels remains uncertain. However, it may be linked to dysfunction in the endothelial lining of the arteries and potential impairments in the regulatory mechanisms controlling vessel constriction and dilation within the smooth muscle cells of the coronary vessels.
Maintaining a delicate balance between the sympathetic and parasympathetic nervous systems is crucial in regulating coronary blood flow. An imbalance in this system can predispose the coronary arteries to excessive constriction even under normal conditions and can further exacerbate spasms when exposed to substances like acetylcholine and methacholine.
Prinzmetal angina can occur due to either diffuse or segmental spasms in the coronary arteries, which reduces blood supply to the heart muscle and results in symptoms such as chest pain.
These spasms can be triggered by various factors, including exposure to cold weather, physical exertion or exercise, or the ingestion of substances that promote blood vessel constriction, such as alpha-agonists like oxymetazoline and pseudoephedrine.
Recreational drug use, particularly the use of cocaine, has been associated with the development of vasospastic angina, especially when used in conjunction with cigarette smoking. This combination of factors can further increase the risk of coronary artery spasms and the associated chest pain symptoms.
The hallmark symptom of Prinzmetal angina is chest pain. It can occur at rest and may wake the patient from sleep. The pain typically lasts for several minutes and can be severe. The pain may radiate to other upper body areas, including the left arm, shoulder, jaw, or neck. Patients with Prinzmetal angina may experience symptoms such as shortness of breath, palpitations, and a sense of impending doom.
Prinzmetal angina typically occurs at rest or during periods of reduced physical activity. It can also happen during sleep, waking the patient from their slumber due to the pain. Episodes of Prinzmetal angina typically last for several minutes but can persist for longer periods. The duration of the chest pain can vary from one episode to another. It is also characterized by recurrent, intermittent episodes of chest pain, with variable intervals of symptom-free periods between episodes.
The patient may experience or report chest discomfort or pain during the examination. This pain is typically described as tightness, squeezing, or pressure in the chest. During an episode of Prinzmetal angina, blood pressure may temporarily increase due to the stress and pain associated with the condition. The heart rate may be assessed, and any irregularities or changes may be noted.
Tachycardia can occur as a response to chest pain and stress. In some cases, a patient’s skin may become pale or sweaty during an episode of chest pain or discomfort. These signs may be related to the body’s response to pain and stress. It’s important to emphasize that Prinzmetal angina is primarily a vasospastic disorder affecting the coronary arteries, and physical examination findings may be normal or inconclusive during symptom-free periods.
Angina Pectoris
Anxiety Disorder
Cocaine Toxicity
Esophageal Spasms
Myocardial Infarction
Calcium antagonists play a crucial role in managing vasospastic angina and are considered a first-line treatment due to their ability to induce vasodilation in the coronary vasculature. They effectively relieve symptoms in approximately 90% of patients with this condition. Additionally, research has shown that calcium channel blocker therapy independently predicts better myocardial infarct-free survival in individuals with vasospastic angina.
To optimize the effectiveness of calcium antagonists in managing vasospastic angina, it is recommended to use a long-acting formulation, particularly at night, as episodes of vasospasm are more frequent during the midnight and early morning hours. High doses of long-acting calcium antagonists such as amlodipine, diltiazem, nifedipine, or verapamil are typically prescribed.
The titration of the medication should be tailored to each patient, aiming for an adequate response while minimizing side effects. In cases where an individual does not respond well to a single calcium antagonist, a combination therapy approach using two different types of calcium antagonists, specifically dihydropyridine and non-dihydropyridine agents, can be considered. This combination therapy may be more effective in patients with a poor response to a single agent.
Lifestyle Modifications
The primary aim of treatment for vasospastic angina is to reduce the frequency of angina episodes and prevent potential complications such as myocardial injury and arrhythmias. Encouraging lifestyle modifications is crucial, with a particular emphasis on smoking cessation. This intervention is a critical component in reducing the occurrence of angina episodes.
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