Causes of variant angina

The temporary tightening is called a coronary artery spasm. Episodes may occur at night or during rest rather than only with exercise. Smoking, stimulant or recreational drug exposure, cold conditions, emotional stress and some medicines can act as triggers. High blood pressure and other blood-vessel risk factors may coexist, but chest symptoms cannot be classified safely from a description alone. Chest tightness, pressure, burning or pain can have heart and non-heart causes.

Arrange medical assessment for repeated chest episodes, especially if they occur at rest, wake you from sleep or follow a possible trigger. Note the time, duration, activity, location, associated breathlessness and medicines taken. A clinician may use an electrocardiogram and other tests to assess heart rhythm and blood flow. Treatment may include medicines that relax coronary arteries; never change prescribed blood pressure or cholesterol treatment without advice.

Call emergency services for chest pain or tightness that is severe, new, prolonged, or accompanied by sweating, nausea, breathlessness, fainting or pain spreading to the arm, jaw or back. Do not drive yourself. Even brief episodes need prompt review because coronary spasm can affect heart muscle blood supply. Angina symptoms merit assessment whether or not you have known hypertension.

Could my episodes represent coronary spasm or another form of angina? Which tests are needed? Are smoking, cold exposure, medicines or stimulants relevant triggers? What should I do if symptoms return, and which treatments are suitable for me?