Prinzmetal Angina

Prinzmetal angina is also called variant angina or vasospastic angina. Prinzmetal variant angina symptoms include chest pain episodes that happen during the night when you’re at rest. Testing may not show coronary artery disease. Medications are part of Prinzmetal angina treatment.


What is Prinzmetal angina?

Prinzmetal angina is a rare and sometimes severe type of angina (chest pain). It usually happens between midnight and the morning while you’re asleep or resting. Prinzmetal (or Prinzmetal’s) angina is also called variant angina, angina inversa and vasospastic angina.

Angina is the term used to describe chest pain caused by inadequate blood flow to the heart muscle, usually caused by coronary artery disease. People who have angina give various descriptions of the pain: discomfort, tightness, pressure, heaviness, burning or squeezing. You might think you’re having indigestion when you’re actually having an angina attack.


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What is the difference between angina and Prinzmetal angina?

Angina typically happens when you’re working hard or during emotional stress. What’s different about Prinzmetal angina is that it usually happens when you’re relaxing or resting. It also usually affects younger, healthier people than those affected by traditional angina (also called ‘classic’ angina).

Who does Prinzmetal angina affect?

Prinzmetal angina affects both men and women. It’s also found in people who have other conditions that are related to blood vessel spasms, such as migraine headaches and Raynaud’s phenomenon. Prinzmetal angina may also affect people who have high cholesterol levels or high blood pressure, but also affects people who don’t have these conditions.

Is it hereditary?

Studies on Prinzmetal angina haven’t shown it to be hereditary. However, some studies indicate that there may be a genetic factor in the condition. For instance, there is a higher occurrence of Prinzmetal angina in Japanese people than white people.


How common is Prinzmetal angina?

The American Heart Association says that Prinzmetal angina accounts for about two out of 100 angina cases and considers the condition to be rare. There’s not a lot of information on how many people have Prinzmetal angina and who’s most likely to have it.

Symptoms and Causes

What are the symptoms of Prinzmetal angina?

If you have Prinzmetal angina, you probably will have:

  • Chest pain or a feeling of discomfort while resting, usually between midnight and 8 a.m. The pain may move to your arm, head or shoulder.
  • Recurrent episodes of pain that last about five to 15 minutes per episode, possibly longer. The episodes tend to form a pattern.
  • Associated symptoms include sweating, nausea and/or dizziness.
  • Relief of symptoms when you take medication.


What causes Prinzmetal angina?

Prinzmetal angina is caused by spasms of the coronary arteries, or the arteries that bring blood and oxygen to your heart. The lack of oxygen causes the pain that you feel. If prolonged, this can cause damage to the heart muscle.

What causes coronary artery spasms?

There are several things that cause the arteries in your heart to spasm. These include:

  • Medications that are intended to constrict (or narrow) blood vessels, such as migraine treatments like sumatriptan or decongestants that contain ephedrine.
  • Use of drugs like marijuana and cocaine.
  • Smoking tobacco.
  • Stress.
  • Exposure to cold.
  • Exercise.

Diagnosis and Tests

How is Prinzmetal angina diagnosed?

Your provider may do the following tests to diagnose Prinzmetal angina.

  • Stress test.
  • Coronary angiography.
  • Ambulatory electrocardiogram.

Because there may be no evidence of heart problems like blocked arteries, your provider might have to try to provoke an episode of Prinzmetal angina using substances such as acetylcholine or ergonovine. Then they can see what happens during an episode of Prinzmetal angina (your arteries are squeezed together and become temporarily blocked). As the spasm is provoked, your doctors will pay attention to how you are feeling and what happens to the EKG during these episodes.

Management and Treatment

How is Prinzmetal angina treated?

Prinzmetal angina is treated with medications and lifestyle changes. The types of drugs used to treat Prinzmetal angina include:

  • Nitrates: These can be given in sublingual tablets, oral tablets or capsules or patches.
  • Calcium channel blockers: These include diltiazem, amlodipine, nifedipine and verapamil.
  • Fluvastatin: A statin medication that may have a positive effect on the lining of the blood vessels.

Medications like beta blockers and aspirin, often used in other heart conditions, aren’t used for Prinzmetal angina.

Lifestyle modifications include quitting smoking and avoiding substances that cause spasms, such as:

  • Drugs, including marijuana or cocaine.
  • Medications that constrict blood vessels, like many migraine treatments, nasal decongestants, weight loss medications and energy drinks.

It’s also a good idea to adopt heart-healthy strategies in terms of diet and exercise to avoid developing blocked arteries. People who have Prinzmetal angina in addition to coronary artery disease have poorer outlooks.


How can I reduce my risk of developing Prinzmetal angina?

Choosing a healthy lifestyle is always a good idea. Try to:

  • Get enough exercise.
  • Reach and maintain a healthy weight.
  • Eat sensibly, including lots of vegetables and fruits in your meals.
  • Get enough sleep.
  • Manage stress.

There are three key things you can avoid doing to reduce your risk of developing Prinzmetal angina:

  • Don’t smoke.
  • Don’t use cocaine.
  • Don’t use other substances like ephedra / ephedrine that may make your vessels spasm. Ephedra is an herb and ephedrine is the active ingredient in ephedra. These substances can be found in some decongestants, cold medicines, weight-loss supplements and energy drinks.

Outlook / Prognosis

What can I expect if I have Prinzmetal angina?

The outlook (prognosis) for someone with Prinzmetal angina is generally good. You’ll still need long-term care and follow-up appointments with experienced cardiologists. The prognosis is less optimistic if you develop arrhythmia or have blocked arteries in addition to Prinzmetal angina.

Is Prinzmetal angina fatal?

No, Prinzmetal angina isn’t fatal. Angina is a symptom, not a disease entity. However, angina indicates that there is a problem with blood flow to the heart, which can lead to heart attacks (myocardial infarction). Untreated Prinzmetal angina could also mean that you are more likely to have heart rhythm problems. These are linked to stroke, sudden cardiac arrest, death and dementia.

Living With

When should I see my healthcare provider about Prinzmetal angina?

If you have any type of chest pain, you should contact your healthcare provider. They are likely to run tests to see what’s causing the pain. If you have severe chest pain, go to the emergency room or call 911. This can be an emergency.

A note from Cleveland Clinic

If you’re diagnosed with Prinzmetal angina (variant angina), follow your provider’s suggestions on lifestyle changes and make sure to take your medication. If you don’t have typical risk factors associated with classic angina (like high cholesterol), you want to keep it that way. The outlook is good if you have Prinzmetal angina, but you still need to follow up over the long term with your provider.

Medically Reviewed

Last reviewed on 09/20/2021.

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