Prinzmetal variant angina: symptoms and care

During a spasm, the affected coronary artery becomes narrower for a short time, reducing blood flow to the heart muscle. The resulting discomfort may feel like pressure, squeezing, heaviness, or burning. Some people also experience shortness of breath, sweating, nausea, dizziness, or discomfort in the jaw, neck, arm, shoulder, or back. Symptoms may appear at night, early in the morning, or at a predictable time, and they may come and go.

Prinzmetal variant angina is different from exertional angina because physical effort is not always the trigger. A symptom such as chest tightness has several possible explanations, so the pattern should be assessed rather than used to self-diagnose. A clinician may use an electrocardiogram and other tests alongside your history.

Seek a planned medical review if episodes recur, occur at rest, or wake you from sleep. Write down the time, setting, sensation, duration, and associated symptoms of each event. Bring a list of prescription medicines, over-the-counter products, and supplements. Treatment may include medicine to reduce artery spasm; your clinician may also review blood pressure, cholesterol, smoking, and possible triggers. Use only medicines prescribed for you and follow the agreed instructions.

Do not assume that a familiar episode is harmless. Tell your clinician if symptoms are becoming more frequent, lasting longer, or changing in character.

Get emergency help for new or severe chest discomfort, symptoms that do not settle promptly, or discomfort with fainting, severe breathlessness, sweating, unusual weakness, or spreading pain in the arm, jaw, back, or shoulder. Stop exertion, sit upright or rest, and follow your prescribed emergency instructions while waiting. Do not drive yourself to hospital.

What features make variant angina more or less likely? What heart tests are appropriate? How should I use my prescribed medicine during an episode? Could another medicine or substance be contributing to spasm? Which changes mean I should call emergency services?