Prinzmetal's Angina: Prognosis & Medication

Instructor: Danielle Haak

Danielle has a PhD in Natural Resource Sciences and a MSc in Biological Sciences

Prinzmetal's angina is a rare form of angina (extreme chest pain) that is usually successfully managed with medication. Complications arise when other forms of cardiovascular disease are present. Let's discuss how Prinzmetal's angina can be managed through medication and the prognosis for people with this condition.

What is Prinzmetal's Angina?

Angina is chest pain that occurs when a coronary artery becomes blocked or constricted, limiting the amount of oxygen-rich blood delivered to the heart. The heart requires a steady supply of oxygen to function, so when oxygen is cut-off, it sends out pain as a warning sign. Most types of angina are known as stable angina because events are predictable and often triggered by physical exertion or exercise.

Prinzmetal's angina is a rare type of angina, comprising only around 2% of all angina cases. This form is a type of unstable angina because events are unpredictable and usually occur at night while a person is at rest. Prinzmetal's angina is caused by a coronary artery spasm, which is an involuntary constriction or tightening of an artery that temporarily cuts off blood flow.

Coronary artery spasms can be triggered by exposure to cold, extreme emotional stress, certain medications, smoking, cocaine use, and hyperventilation. They may also be caused by different types of cardiovascular disease (any condition negatively affecting the heart or network of blood vessels in the body).

The most common symptom is severe chest pain, lasting between 5 and 30 minutes. Symptoms can usually be managed through the use of medication.

Prinzmetal's Angina Medication

There are two types of medication used to treat Prinzmetal's angina. The first is a short-term medication called nitroglycerin. When a patient begins feeling symptoms (usually chest pain), they take nitroglycerin to stop the spasm. This is only used for immediate relief and is not a viable long-term medication option.

The second type of medication used to treat Prinzmetal's angina is a long-term option. Calcium channel blockers and long-term nitrates are two medications that can be used for long-term preventative treatment. They work by widening the affected arteries to improve blood flow (and thus oxygen delivery) to the heart.

Prognosis

Patients with managed Prinzmetal's angina have high survival rates. Typically, angina events are clustered into 3-6 month periods, followed by long periods with no events or symptoms. Long-term medication use can limit the frequency of recurring events over time. Lifestyle changes such as quitting smoking improve survival rates even more.

Smoking can trigger coronary artery spasms.
No smoking

The long-term prognosis gets worse if Prinzmetal's angina is present with another type of cardiovascular disease, like atherosclerosis. This is the hardening of arteries due to the buildup of fats and other deposits. Over time, this accumulation narrows the blood vessel, limiting blood flow. If atherosclerosis affects multiple arteries, long-term survival rates decrease. This is because bouts of angina may be amplified by other conditions, leading to a heart attack or even heart failure.

In general, prognosis is improved by maintaining a healthy diet and weight, controlling blood pressure and cholesterol, taking medication as prescribed, and avoiding excessive psychological stress.

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