Prinzmetal's Angina: Symptoms & Treatment

Instructor: Danielle Haak

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

Prinzmetal's angina is a type of angina (chest pain) caused by coronary artery spasms. The primary symptom is extreme pain, and in this lesson we'll take a look at other possible symptoms as well as treatment options.

What is Prinzmetal's Angina?

Angina is the medical term used to describe chest pain caused by a disruption in oxygen-rich blood flow to the heart. This occurs when the blood vessels tasked with delivering oxygenated blood, called coronary arteries become blocked or restricted, limiting the amount of blood that can pass through. When the arteries are blocked, the heart can't get enough blood and becomes deprived of oxygen. This oxygen deprivation causes the extreme chest pain characteristic of angina.

Prinzmetal's angina is a rare form of angina caused by coronary artery spasms. This type usually occurs when a person is at rest, often in the middle of the night, and is unpredictable. As a result, it's referred to as unstable angina. This is in contrast to angina brought on by exertion or exercise, which is usually predictable and thus referred to as stable angina. Prinzmetal's angina only accounts for about 2% of angina cases.

Symptoms of Prinzmetal's Angina

Some spasms may have no symptoms at all, though this is rare. The most common symptom of Prinzmetal's angina is extreme chest pain that typically lasts between 5 and 30 minutes. This pain can radiate out to the neck, jaw, upper abdomen, shoulders, and arms, and it might also cause a tingling or feeling of pressure. A person experiencing a coronary artery spasm may feel like it's hard to catch their breath, faint, or temporarily lose consciousness.

If a person also suffers from other types of cardiovascular disease (any condition affecting the heart or network of blood vessels in the body), Prinzmetal's angina may trigger a heart attack or other cardiac event. Heart attacks occur when the heart's cells begin dying due to oxygen deprivation. If a coronary artery spasm lasts too long, it may trigger a heart attack.

Treating Prinzmetal's Angina

Prinzmetal's angina is a chronic condition that requires long-term monitoring and treatment. The most common treatment type is medication. For immediate treatment upon developing symptoms (usually pain), nitroclycerin can be used to stop the spasm, thus relieving pain.

Nitroglycerin is used to treat immediate angina symptoms and works by stopping the coronary artery spasm.
Nitroglycerin structure

For long-term preventative treatment, calcium channel blockers and long-term nitrates are used. These work by widening (or dilating) the blood vessels to improve blood flow and oxygen delivery to the heart. Prinzmetal's angina sometimes occurs in cycles, so treatment may be tailored to a patient's cycle. For example, a person may experience angina episodes for 6 months and then go many weeks or months with no symptoms. In this case, they may be treated with medication for the 6 months and then stop until the next cycle begins.

Lifestyle changes may also be necessary once someone is diagnosed with Prinzmetal's angina. The most common change is to quit smoking if the person is a smoker. Smoking is a huge trigger to angina. They may also be advised to avoid exposure to cold and stressful situations, since these are other known triggers.

With medication, the prognosis for someone with Prinzmetal's angina is good, and pain can usually be successfully treated. However, the prognosis gets worse if the patient also suffers from another type of cardiovascular disease.

If medication isn't enough to control Prinzmetal's angina, a surgical procedure called a stent implantation may be used. This procedure involves inserting a tiny tube (or stent) into the affected artery, and the tube acts as a type of scaffolding to hold the artery open. Stents are permanent treatment options that can help prevent arteries from narrowing.

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