• Variant Angina: Heart Spasms

    Image for coronary spasm article Whenever we think chest pain, we think heart attack . And that’s important because any type of chest pain is a serious warning and should be evaluated by a doctor immediately. But it could also be an unusual form of angina . A type that occurs at rest called variant angina.

    What is Variant Angina?

    Most of us have heard of angina, chest pain most commonly linked to heart attacks. But did you know there are several types of angina, including:
    • Stable angina—This form has a predictable pattern. It generally occurs when a blocked artery causes reduced blood flow to the heart when the heart is working hard. Emotional stress or physical activity can make your heart work harder. As a result, stable angina appears when you are physically active or emotionally charged.
    • Unstable angina—This type is more unpredictable. Chest pain may develop at any time during any activity. It may be a sign that you are about to have a major heart attack. It should be treated as an emergency.
    • Microvascular angina—This is a type of angina in which people have chest pain but no apparent coronary artery blockages. This type of chest pain is caused by problems in the tiny blood vessels that nourish the heart, arms, and legs.
    • Variant angina—This form is characterized by a sudden, temporary narrowing or tightening of a coronary artery. Variant angina is also called atypical angina, or Prinzmetal’s angina.
    Most types of angina are caused by problems with blood vessels and are often triggered by either physical or emotional exertion. But variant angina is caused by a coronary artery spasm. It generally occurs when you are at rest, often between the hours of 12:00 p.m. and 8:00 a.m. It is rare, but can be very painful and frightening.

    Coronary Artery Spasm

    Coronary artery spasm is a sudden, temporary narrowing or tightening of a small part of an artery. The artery supplies blood to the heart. This spasm results in the heart temporarily not getting enough blood. The blockage of blood causes you to feel chest pain.
    Coronary artery spasm can occur in people who do not have significant coronary artery disease (CAD). However, some people with variant angina have severe disease in at least one vessel. The spasm typically occurs at the site of blockage. Fortunately, coronary artery spasm does not typically trigger the series of events that can lead to a heart attack. But if a coronary artery spasm is severe and occurs for a long period of time, a heart attack can occur.
    Coronary artery spasm may be triggered by emotional stress, exposure to cold, cocaine use, or heavy smoking. People who have underlying coronary artery disease, hypertrophic cardiomyopathy (an enlarged heart due to disease), or uncontrolled high blood pressure are also at an increased risk of variant angina.

    What are the Symptoms of Variant Angina?

    The symptoms of variant angina include:
    • Chest pain that feels like a strangling or heavy pressure on the chest
    • Pain that starts in the chest and spreads to the throat, arms (usually the left arm), jaw, and between the shoulder blades (It can also spread to the stomach and feel like an ulcer or indigestion.)
    • A feeling of tightness or heaviness in the chest
    • Nausea
    • Sweating
    • Light-headedness
    • Trouble breathing
    • Palpitations (rapid or irregular heartbeats), skipped beats, or a “flip-flop” feeling in your chest

    How Is Variant Angina Diagnosed?

    If your doctor suspects you have variant angina, she will examine you and order an electrocardiogram (ECG). The ECG will record your heart rhythms and may show certain changes indicating that your pain is being caused by coronary spasm. Your doctor may also ask you to wear a small, portable ECG recorder called a Holter monitor for 24-72 hours. Like an ECG, this monitor also records your heart rhythms. In some cases, you may also be asked to take a stress or treadmill ECG. During this type of ECG, your heart’s activity is recorded while you are under stress (ie, exercising). Your doctor may also order a panel of blood tests to determine whether any significant heart injury has occurred or is likely to occur.
    Finally, your doctor may order a coronary angiogram , a special x-ray that uses a dye to create images of your arteries. This test can show your doctor any blockages in your arteries. During this test, you may actually be given a medicine designed to trigger a coronary spasm. This is done to help locate on the x-ray exactly where the spasm is occurring.

    How Is Variant Angina Treated?

    Variant angina is often treated with drugs called calcium channel blockers. These drugs can decrease variant angina attacks and are often used in combination with nitrates. If, however, your angina is being caused by a severe blockage, your doctor may schedule a procedure to treat it.
    The goal of treating variant angina is to stop the symptoms. Your doctor will work with you to come up with a plan that includes:
    • Stopping the use of any drugs that cause coronary artery spasm
    • Taking medication to help prevent coronary spasm
    • Reviewing your lifestyle and habits to reduce your risk for heart disease
    • Having frequent follow-up appointments to check your progress
    • Quitting smoking

    What Can You Do?

    Remember that many types of chest pain aren’t related to angina at all. For example, heartburn or inflammation of the lungs may also cause chest pain. However, there is no way for you, especially if you are at home and frightened, to distinguish one type of chest pain from another. Therefore, any chest pain you experience should be evaluated by a doctor right away.
    However, if you have a history of variant angina, there are some things you can do to take care of yourself, such as:
    • Taking medicine as directed by your doctor
    • Avoiding drugs that may worsen your condition
    • Reporting any new symptoms to your doctor right away
    • Learning how anxiety and stress affect you and develop methods to help you cope more effectively

    RESOURCES

    American Heart Association http://www.americanheart.org

    National Women's Health Information Center http://www.womenshealth.gov/

    CANADIAN RESOURCES

    Canadian Cardiovascular Society http://www.ccs.ca/home/index%5Fe.aspx

    Heart and Stroke Foundation of Canada http://www.heartandstroke.com/

    References

    Angina. Texas Heart Institute website. Available at: http://www.texasheartinstitute.org/hic/topics/cond/angina.cfm. Updated September 2011. Accessed May 2, 2012.

    Angina pectoris. American Heart Association website. Available at: http://www.americanheart.org/presenter.jhtml?identifier=4472 . Accessed October 17, 2003.

    Angina pectoris treatments. American Heart Association website. Available at: http://www.americanheart.org/presenter.jhtml?identifier=4496 . Accessed October 17, 2003.

    Chest pain (angina). Heart Healthy Women.org website. Available at: http://www.hearthealthywomen.org/cardiovascular-disease/featured/chest-pain-angina.html. Accessed May 2, 2012.

    Coronary artery disease. The Merck Manual—Home Edition website. Available at: http://www.merck.com/mrkshared/CVMHighLight?file=/mrkshared/mmanual%5Fhome/sec3/27.jsp%3Fregion%3Dmerckcom&word=chest&word=pain&domain=www.merck.com#hl%5Fanchor . Accessed October 20, 2003.

    Coronary spasm. University of Michigan Health Center website. Available at: http://www.med.umich.edu/1libr/aha/aha%5Fcoronsps%5Fcrs.htm . Accessed October 17, 2003.

    Facts about angina. National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/public/heart/other/angina.htm . Accessed October 20, 2003.

    Mild heart attack: symptoms & causes. Heart Healthy Women.org website. Available at: http://www.hearthealthywomen.org/cardiovascular-disease/unstable-angina-mild-heart-attack/mha2.html. Accessed May 2, 2012.

    Mild heart attack & unstable angina. Heart Healthy Women.org website. Available at: http://www.hearthealthywomen.org/cardiovascular-disease/unstable-angina-mild-heart-attack/mild-heart-attack.html. Accessed May 2, 2012.

    Prinzmetal's angina. Heart Healthy Women.org website. Available at: http://www.hearthealthywomen.org/cardiovascular-disease/prinzmetals-angina/prinzmetals-angina.html. Accessed May 2, 2012.

    Prinzmetal's angina: diagnosis & treatment. Heart Healthy Women.org website. Available at: http://www.hearthealthywomen.org/cardiovascular-disease/prinzmetals-angina/prinzmetals-angina-2.html. Accessed May 2, 2012.

    Prinzmetal's angina, variant angina and angina inversa. American Heart Association website. Available at: http://www.heart.org/HEARTORG/Conditions/HeartAttack/SymptomsDiagnosisofHeartAttack/Prinzmetals-Angina-Variant-Angina-and-Angina-Inversa%5FUCM%5F435674%5FArticle.jsp. Accessed May 14, 2012.

    Theroux P, Waters D. Diagnosis and management of patients with unstable angina. In: Hurst’s The Heart. 9th ed. 1998;46:1333.

    Variant angina pectoris. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/. Updated September 13, 2010. Accessed May 2, 2012.

    What are the symptoms of coronary artery disease? Cleveland Clinic Heart Center website. Available at: http://www.clevelandclinic.org/heartcenter/pub/guide/disease/cad/cadsymptoms.htm. Accessed October 20, 2003.

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