Vasospastic Angina (Formerly Known as Prinzmetal Angina)

Vasospastic angina is a type of chest pain that happens when your heart’s arteries briefly tighten and then relax. These spasms temporarily reduce blood flow to your heart muscle, leading to the pain that you feel. These episodes typically occur overnight when you’re asleep, but they may happen at any time.

Diagnosing vasospastic angina may be difficult. This is because it’s important to make sure the chest pain isn’t due to obstructive coronary artery disease (a blockage in your heart’s arteries), although both conditions can exist together.

Treatment for vasospastic angina includes medications you take daily to reduce how often spasms occur. Your provider may also prescribe medication to stop the spasms and relieve pain during an episode.

Older names for this symptom include Prinzmetal angina and variant angina. “Prinzmetal” is the name of the cardiologist who first described this type of angina in 1959. He called it a “variant form” because it was different from stable angina. That form happens during the day in response to triggers like exercise or stress.

What do you experience with vasospastic angina?

Call 911 or your local emergency number if you have chest pain that’s severe or occurs without warning. This may be a sign of a heart attack.

Vasospastic angina often happens when you’re sleeping or resting — commonly between the hours of midnight and 8:00 a.m. The pain may be severe. It can wake you from sleep and cause stress or anxiety.

Episodes tend to recur, meaning they come back. They also tend to follow the same pattern of happening at night. An episode usually lasts about five to 15 minutes. But it may last for up to 30 minutes.

A vasospastic angina attack can progress to a heart attack if your heart goes too long without blood flow. The chest pain may get worse or spread to your back, shoulder, arm or jaw. You may also have other symptoms, like shortness of breath, nausea or profuse sweating. A heart attack is a medical emergency. Seek care immediately.

What are the most common causes of vasospastic angina?

Coronary artery spasms cause vasospastic angina. A spasm means one or more of the arteries that supply blood to your heart suddenly tighten. Each artery is normally like a tube with open space for blood to flow through. But when an artery tightens, its walls squeeze shut. It’s like if you pinch a straw. This makes it hard for blood to reach your heart muscle.

These spasms can last anywhere from five to 30 minutes. While the spasm is happening, you feel vasospastic angina. The pain goes away once your artery relaxes and blood flow resumes. An episode may go away on its own or when you take medication that your provider prescribes.

Vasospastic angina affects people at a younger age than the more “classic” form of angina (stable angina), which occurs due to coronary plaque buildup. Smoking is one of the biggest risk factors for both types.

Some people with vasospastic angina also have other conditions that involve blood vessel tightening. These include migraines and Raynaud’s syndrome. Experts continue to learn more about these links.

How is this symptom treated?

Healthcare providers prescribe medications to treat the underlying cause of vasospastic angina (coronary artery spasms) and manage episodes as they occur. Medications you may need include:

• Calcium channel blockers: This is the first-line medication for vasospastic angina. It can prevent the spasms that lead to the pain.
• Long-acting nitrates: Your provider may prescribe long-acting nitrates along with calcium channel blockers. Each one works in a different way to reduce coronary spasms that lead to vasospastic angina.
• Nitroglycerin: This drug treats attacks as they’re happening. You might hear it called “sublingual nitroglycerin” because you place a tablet under your tongue and let it dissolve. It can typically relieve symptoms within one to three minutes.
• Statins: Your provider may prescribe a statin along with your other medications. It may reduce how often coronary spasms and vasospastic angina occur. It can also lower your risk of other heart and blood vessel problems.

Your provider will also talk with you about lifestyle changes, including:

• Quitting smoking: Smoking is a major risk factor for coronary artery spasms (the underlying cause of vasospastic angina). It can also trigger angina episodes. If you smoke, your provider can help you come up with a plan for quitting.
• Avoiding addictive substances: Certain substances like alcohol, cocaine, ecstasy and amphetamines can trigger vasospastic angina episodes.
• Eating heart-healthy foods: Following a Mediterranean or DASH style of eating can help lower your risk of plaque buildup in your coronary arteries. This is important because plaque buildup on top of spasms can worsen your outlook.
• Moving around more: Physical activity also helps protect your heart. Try to add movement to your daily routine, like parking farther away or taking the stairs instead of the elevator. Also aim for at least 150 minutes of planned exercise per week.

When you have this symptom, it’s also important to keep an eye on the medications you’re taking for other conditions. Certain ones can trigger coronary spasms and related angina. Known examples include triptans (which treat migraines) and beta-blockers. Your provider can review your medication list with you and switch you to safer ones, if needed.

What are the risks of not treating it?

Treatment for vasospastic angina is very important and can be lifesaving. This symptom means that there’s a problem with blood flow to your heart.

Spasms that last a long time may reduce blood flow so much that you have a heart attack. They can also lead to dangerous heart rhythms in your heart’s lower chambers (ventricular arrhythmias). Such rhythms raise your risk of sudden cardiac death.

When should this symptom be treated by a healthcare provider?

Contact a provider if you have any type of chest pain. It’s not always easy to tell the type or the cause as it’s happening. A provider will run tests to find the cause and guide treatment.

Tests that can diagnose vasospastic angina include coronary angiography, an electrocardiogram (EKG/ECG) at the hospital or your provider’s office, and EKG/ECG monitors you wear at home. This type of angina causes unusual results on an EKG graph that shows your heart’s electrical activity. Your provider will interpret the test results and let you know any next steps.