Prinzmetal angina symptoms: what to know

The discomfort may feel squeezing, tight, heavy, burning, or sharp. It can spread to the arm, shoulder, neck, jaw, or back, and may occur with shortness of breath, sweating, nausea, dizziness, or a fast or irregular heartbeat. Symptoms can settle when the spasm relaxes, but chest pain should not be self-diagnosed as Prinzmetal angina.

Prinzmetal angina, also called vasospastic angina, happens when a coronary artery tightens briefly and reduces blood flow to the heart muscle. Unlike the pattern many people associate with exertional angina, an episode often begins while you are resting, relaxing, or asleep, particularly in the late night or early morning. Some people notice a repeated pattern at a similar time of day.

An episode may last several minutes and can come in waves. Some people have few symptoms between episodes. A normal examination or an ECG recorded between episodes does not by itself explain every episode, so the timing, triggers, duration, and associated symptoms are useful details for a clinician. Other heart and lung problems can also cause chest discomfort.

Stop what you are doing, sit upright, and note when the episode began and what you felt. Do not drive yourself if the pain is severe, unfamiliar, or accompanied by breathing trouble, faintness, or marked weakness. Arrange medical assessment for recurring chest symptoms, including episodes that happen at rest or wake you from sleep.

A clinician may ask about tobacco or stimulant exposure, medicines, migraine or Raynaud-type symptoms, and cardiovascular risk factors. Assessment may include an electrocardiogram and other tests chosen for your symptoms. If Prinzmetal angina is diagnosed, treatment is prescribed to reduce artery spasm; do not start, stop, or change heart medicines without medical advice.

Call emergency services immediately for chest pain or pressure that is severe, lasts longer than expected, returns repeatedly, or feels different from your usual episodes. Seek urgent help as well if it comes with shortness of breath, cold sweating, nausea, fainting, confusion, a very fast or irregular heartbeat, or pain spreading to the arm, jaw, neck, or back.

These warning signs can indicate a heart attack or another emergency, even if the discomfort improves. While waiting for help, rest and follow the instructions of emergency services. Do not rely on a previous diagnosis of vasospastic angina to explain away a new or changing pattern.

Ask what features of your episodes support vasospastic angina and what other causes need checking. You can also ask whether you need an ECG during symptoms or further monitoring, which medicines are appropriate, which substances or activities may trigger spasm, and what personal action plan to follow if pain returns.