Vasospastic Angina

Vasospastic (Variant/Prinzmetal) Angina¶

Pathophysiology¶

• Vascular smooth muscle dysfunction leads to diffuse or focal spasm of the coronary arteries
• Transient myocardial ischemia, and resulting angina
• Hyperreactivity of coronary SM

Risk Factors¶

• RF: Smoking, young (<50 y/o), ± CAD/Hypertension/diabetes

Symptoms¶

• Symptoms are recurrent, occur at rest/sleep, and can be worse at night
  • Spontaneous resolution ≤15mins
• Cigarette smoking is a known risk factor
• Exercise tolerant (won't show up on stress test)
• ECG: Contiguous ST elevation during asymptomatic/transient myocardial ischemia
• No CAD on coronary angiography

Diagnosis¶

• IV Ergonovine or Acetylcholine stimulation test to diagnose via coronary angiography to provoke vasoconstriction
  • Sudden Cardiac Arrest + Medical Therapy
  • ICD is reasonable if meaningful survival is >1 year (IIa)
• Sudden Cardiac Arrest + Medical Therapy
  • ICD is reasonable if meaningful survival is >1 year (IIb)

Treatment¶

• Nitrates (absorptive + CCBs) (preventative)
  • Nitrates can induce coronary artery spasm (Use with caution)
• CCBs/Metoprolol long-term (1^st line)
  • Acute Exacerbation: IV Metoprolol/Verapamil (CCBs)
• Amiodarone/Ablation/Cardioversion do work in MAT