Understanding Angina: Vasospastic Angina

This is part eight of our series entitled the heart of the matter. Part seven can be found here. Please read our disclaimer.

This is an atypical kind of angina that occurs due to severe spasm (squeeziness) of the muscles of the heart artery wall, in response to severe nervous stress. It typical occurs perhaps under mental stress, and not physical stress, takes awhile to subside, even with rest, but responds well to sublingual glyceryl trinitrine tablets. (ED: Interestingly enough this is the same chemically as nitroglycerine 1,2,3-Trinitrooxypropane)

For it’s definite diagnosis it requires an ECG change of ST segment elevation on the ECG, during the episode of chest pains and resolution of the ST segment change on ECG when the pain is abolished. The diagnosis has to be definite as the treatment is medical and the patient does not usually require any form of cardiac intervention.

Fig 3 ECG changes typical of vasospastic angina. Severe ST elevation in leads V1, V3, V4 which return to normal after cessation of the chest pains.

(ED: Please do note attempt self diagnosis. Consult your physician and read our disclaimer .)

This form of atypical angina, had been called by many names, eg Prinzmetal angina, variant angina, vasospastic angina or syndrome X. The management of the form of angina is largely medical, and interventions does not seem to help, although an angiogram is sometimes done, more to exclude atherosclerotic coronary artery disease.

In the next part of the series we will be discussing heart attacks.