Here is a list of common questions related to Prinzmetal's Angina:
Prinzmetal's Angina, also called variant angina, is a relatively uncommon cause of chest pain. It occurs when a spasm strikes in one of the coronary arteries — the arteries that supply blood to your heart. While the condition can feel scary, it is often treatable and the prognosis is generally good.
The primary symptom is pain or discomfort in the chest, usually presenting as tight, gripping or squeezing, and can vary from mild to severe. It usually occurs while resting, during the night or early morning hours, and frequently in cycles.
The pain is often felt in the center of the chest, but may spread to either or both shoulders, back, neck, jaw or arms. Some people do not feel pain, just an unpleasant sensation or discomfort in their chest, or only shortness of breath rather than pain.
The condition is made better when patients take medication, avoid stress, stay warm, quit smoking, limit alcohol, and seek immediate treatment when symptoms are not resolved (with nitroglycerin).
The condition is made worse when patients are non-medicated, stressed, exposed to cold weather, smokers, or who consume drugs (especially cocaine) or medicine that tightens or narrows blood vessels (epinephrine, sumatriptan, etc.).
To diagnose the condition, you may need to wear a Holter monitor for up to forty-eight (48) hours. The monitor records your heart's electrical impulses, even during sleep. If you have chest pain in the middle of the night, for example, doctors may be able to see changes on the electrocardiogram (EKG) that indicate coronary spasm. However, not all patients show EKG changes during every episode.
To confirm the diagnosis, an ergonovine stress test can be conducted. Ergonovine is a drug that is injected intravenously and can trigger coronary spasm, usually within minutes, at which point another medication is injected to stop it. Before, during and after the attack, your EKG is monitored. Doctors can usually see coronary spasm on an angiogram, as well.
The angina (chest pain) is usually relieved by nitroglycerin. For some, long-acting nitroglycerin can help prevent angina attacks. However, most people with coronary spasm also require calcium blockers — often in larger-than-normal doses.
In some cases, a combination of different types of drugs may be needed. The medications and dosing are individualized for each patient and additional treatments (often co-administered) include low-dose Aspirin (81mg/day), fish oil, magnesium-oxide, L-Arginine (9.1g/day), and other heart medications.
A recent study indicates there may be a hereditary link to Prinzmetal's Angina. A mutation in the eNOS (T-786C) gene indicates greater risk for the condition as it decreases the conversion of L-Arginine to nitric oxide (NO), promoting coronary artery spasm and, subsequently, angina.
In the study, many patients found relief with supplementation of L-Arginine (9.1g/day) - starting with 1g and increasing until the therapeutic dose is achieved.
The prognosis is generally good, especially for patients without prior heart history or underlying coronary artery disease (CAD).
The symptoms tend to come in cycles – appearing for a time, then going away. After 6 to 12 months of treatment, doctors may gradually reduce the medication. However, it is a chronic condition that will need to be followed closely by your healthcare provider.