Prinzmetal's Angina Pain

Angina is a heart condition in which people experience severe chest pain or discomfort because of a decrease in blood flow to the heart. Prinzmetal's angina is the rarest of the three types of angina and occurs because of a spasm in the coronary artery. People with Prinzmetal's angina, as with all types of angina, often experience bouts of pain or tightness in the chest as a sign of the condition. Prinzmetal's angina is sometimes called "variant angina."

Pain

• The hallmark of Prinzmetal's angina is chest pain, as with the other types of angina. However, the pain is often experienced differently in people Prinzmetal's angina. People with stable angina typically develop chest pain while they are exercising or otherwise exerting themselves. With Prinzmetal's angina, the pain strikes while people are at rest and never establishes a predictable pattern. Chest pain caused because of Prinzmetal's angina typically occurs is a different pattern; people experience a series of attacks for a few weeks or months and then a break with no pain.

Other Symptoms

• Pain is the classic symptom of Prinzmetal's angina, but people with the condition also may experience chest tightness, nausea and vomiting, shortness of breath and fatigue. Additionally, the pain is not always felt only in the chest. In some people, it may radiate to the jaw, back, shoulder, arms or neck.

Cause

• The cause of the coronary artery spasms that lead to the pain associated with Prinzmetal's angina is unknown, but researchers believe they may result from problems with the endothelium, the thin lining surrounding blood vessels. Once the coronary artery goes into spasm, the artery walls tighten and blood flow to the heart is either slowed or stopped, causing pain.

Diagnosis

• As with many medical conditions, diagnosis typically begins with the doctor performing a physical exam and taking a complete medical history, including asking about any symptoms of angina. Diagnostic tests that are frequently used to diagnose Prinzmetal's angina include cardiac catheterization, in which the doctor looks for spasms in the coronary artery while chest pain is being felt, and an electrocardiogram, or EKG.

Treatment

• Medications are available to help treat people with Prinzmetal's angina, including nitroglycerin, calcium channel blockers and long-acting nitrates. All these medications work similarly: widening blood vessels to improve blood flow to the heart. Nitroglycerin is typically given to people experiencing the pain from an angina attack, while calcium channel blockers are normally the first choice for controlling the condition. In patients who do not respond to these medications, alpha blockers can be prescribed.