Skip to main content
Clinical Cardiology logoLink to Clinical Cardiology
. 2009 Feb 3;21(4):243–246. doi: 10.1002/clc.4960210403

Prinzmetal's variant angina

Susan Mayer 1, L David Hillis 1,
PMCID: PMC6655445  PMID: 9562933

Abstract

Although the prevalence of variant angina pectoris is unknown, it appears to be substantially less common than typical, exertional angina and unstable angina at rest. The patient with variant angina typically complains of a pressure‐like, squeezing retrosternal chest discomfort of several minutes duration. The diagnosis is secured by the occurrence of transient ST‐segment elevation in association with chest pain, both of which resolve spontaneously or with nitroglycerin. After the diagnosis is made, the patient usually becomes symptom‐free on calcium‐channel blockers with or without long‐acting nitrates. Although the long‐term survival of these patients is excellent, an occasional individual with variant angina sustains a complication, most often myocardial infarction, a life‐threatening arrhythmia, or sudden cardiac death.

Keywords: Prinzmetal's angina, variant angina, vasospasm, vasoconstriction

Full Text

The Full Text of this article is available as a PDF (449.0 KB).

References

  • 1. Prinzmetal M, Kennamer R, Merliss R, Wada W, Bor N: Angina pectoris. I. A variant form of angina pectoris. Am J Med 1959; 27: 375–388 [DOI] [PubMed] [Google Scholar]
  • 2. MacAlpin RN, Kattus AA, Alvaro AB: Angina pectoris at rest with preservation of exercise capacity: Prinzmetal's variant angina. Circulation 1973; 47: 946–958 [DOI] [PubMed] [Google Scholar]
  • 3. Bott‐Silverman C, Heupler FA: Natural history of pure coronary artery spasm in patients treated medically. J Am Coll Cardiol 1983; 2: 200–205 [DOI] [PubMed] [Google Scholar]
  • 4. Maseri A, L'Abbate A, Pesola A, Ballestra AM, Marzilli M, Maltinti G, Severi S, De Nes DM, Parodi O, Biagini A: Coronary vasospasm in angina pectoris. Lancet 1977; 1: 713–717 [DOI] [PubMed] [Google Scholar]
  • 5. Yamagishi M, Miyatake K, Tamai J, Nakatani S, Koyama J, Nissen SE: Intravascular ultrasound detection of atherosclerosis at the site of focal vasospasm in angiographically normal or minimally narrowed coronary segments. J Am Coll Cardiol 1994; 23: 352–357 [DOI] [PubMed] [Google Scholar]
  • 6. Willerson JT, Hillis LD, Winniford MD, Buja LM: Speculation regarding mechanisms responsible for acute ischemic heart disease syndromes. J Am Coll Cardiol 1986; 8: 245–250 [DOI] [PubMed] [Google Scholar]
  • 7. Shepherd JT, Katsic ZS: Endothelium‐derived vasoactive factors: I. Endothelium‐dependent relaxation. Hypertension 1991; 18 (suppl III): 76–85 [DOI] [PubMed] [Google Scholar]
  • 8. Kaski JC, Maseri A, Vejar M, Crea F, Hackett D: Spontaneous coronary artery spasm in variant angina is caused by a local hyperreactivity to a generalized constrictor stimulus. J Am Coll Cardiol 1989; 14: 1456–1463 [DOI] [PubMed] [Google Scholar]
  • 9. Okumura K, Yasue H, Matsuyama K, Ogawa H, Kugiyama K, Ishizaka H, Sumida H, Fujii H, Matsunaga T, Tsunoda R: Diffuse disorder of coronary artery vasomotility in patients with coronary spastic angina: Hyperreactivity to the constrictor effects of acetylcholine and the dilator effects of nitroglycerin. J Am Coll Cardiol 1996; 27: 45–52 [DOI] [PubMed] [Google Scholar]
  • 10. Kuga T, Egashira K, Inou T, Takeshita A: Correlation of basal coronary artery tone with constrictive response to ergonovine in patients with variant angina. J Am Coll Cardiol 1993; 22: 144–150 [DOI] [PubMed] [Google Scholar]
  • 11. Nakamura Y, Tsutomu Y, Inoki I, Takemori H, Katsuki T, Takata S, Kobayashi K: Vasomotor response to ergonovine of epicardial and resistance arteries in the nonspastic vascular bed in patients with vasospastic angina. Am J Cardiol 1994; 74: 1006–1010 [DOI] [PubMed] [Google Scholar]
  • 12. Nobuyoshi M, Abe M, Nosaka H, Kimura T, Yokoi H, Hamasaki N, Shindo T, Kimura K, Nakamura T, Nakagawa Y, Shiode N, Sakamoto A, Kakura H, Iwasaki Y, Kim K, Kitaguchi S: Statistical analysis of clinical risk factors for coronary artery spasm: Identification of the most important determinant. Am Heart J 1992; 124: 32–38 [DOI] [PubMed] [Google Scholar]
  • 13. Caralis DG, Deligonul U, Kern M, Cohen JD: Smoking is a risk factor for coronary spasm in young women. Circulation 1992; 85: 905–909 [DOI] [PubMed] [Google Scholar]
  • 14. Sugiishi M, Takatsu F: Cigarette smoking is a major risk factor for coronary spasm. Circulation 1993; 87: 76–79 [DOI] [PubMed] [Google Scholar]
  • 15. Lange RA, Cigarroa RG, Yancy CW Jr, Willard JE, Popma JJ, Sills MN, McBride W, Kim AS, Hillis LD: Cocaine‐induced coronary artery vasoconstriction. N Engl J Med 1989; 321: 1557–1562 [DOI] [PubMed] [Google Scholar]
  • 16. Igawa A, Miwa K, Miyagi Y, Fujita M, Inoue H: Comparison of frequency of magnesium deficiency in patients with vasospastic angina and fixed coronary artery disease. Am J Cardiol 1995; 75: 728–731 [DOI] [PubMed] [Google Scholar]
  • 17. Miwa K, Igawa A, Miyagi Y, Fujia M: Importance of magnesium deficiency in alcohol‐induced variant angina. Am J Cardiol 1994; 73: 813–816 [DOI] [PubMed] [Google Scholar]
  • 18. Mauritson DR, Peshock RM, Winniford MD, Stern L, Johnson SM, Hillis LD: Prinzmetal's variant angina: Is it transmitted genetically? Am Heart J 1982; 103: 1049–1050 [DOI] [PubMed] [Google Scholar]
  • 19. Ozaki Y, Keane D, Serruys P: Fluctuation of spastic location in patients with vasospastic angina: A quantitative angiographic study. J Am Coll Cardiol 1995; 26: 1606–1614 [DOI] [PubMed] [Google Scholar]
  • 20. Onaka H, Hiroti Y, Shimada S, Kita Y, Sakai Y, Kawakami Y, Suzuki S, Kawamura K: Clinical observation of spontaneous anginal attacks and multivessel spasm in variant angina pectoris with normal coronary arteries: Evaluation by 24‐hour 12‐lead electrocardiography with computer analysis. J Am Coll Cardiol 1996; 27: 38–44 [DOI] [PubMed] [Google Scholar]
  • 21. Ozaki Y, Keane D, Serruys P: Progression and regression of coronary stenosis in the long‐term follow‐up of vasospastic angina. Circulation 1995; 92: 2446–2456 [DOI] [PubMed] [Google Scholar]
  • 22. Previtali M, Ardissino D, Barberis P, Panciroli C, Chimienti M, Salerno JA: Hyperventilation and ergonovine tests in Prinzmetal's variant angina pectoris in men. Am J Cardiol 1989; 63: 17–20 [DOI] [PubMed] [Google Scholar]
  • 23. Miwa K, Goto M, Lee JD, Matsuyama F, Shimizu H, Kato T, Hara A, Nakamura T: Supersensitivity of coronary arteries in variant angina to spasm induced by intracoronary acetylcholine. Am J Cardiol 1988; 61: 77–82 [DOI] [PubMed] [Google Scholar]
  • 24. Suzuki Y, Tokunaga S, Ikeguchi S, Miki S, Iwase T, Tomita T, Murakami T, Kawai C: Induction of coronary artery spasm by intracoronary acetylcholine: Comparison with intracoronary ergonovine. Am Heart J 1992; 124: 29–47 [DOI] [PubMed] [Google Scholar]
  • 25. Raizner AE, Chahine RA, Ishimori T, Verani MS, Zacca N, Jamal N, Miller RR, Luchi RJ: Provocation of coronary artery spasm by the cold pressor test: Hemodynamic, arteriographic, and quantitative angiographic observations. Circulation 1980; 62: 925–932 [DOI] [PubMed] [Google Scholar]
  • 26. Previtali M, Panciroli C, DePonti R, Chimienti M, Montemartini C, Salerno JA: Time‐related decrease in sensitivity to ergonovine in patients with variant angina. Am Heart J 1989; 117: 92–99 [DOI] [PubMed] [Google Scholar]
  • 27. Lombarsi M, Morales C, Michelassi M, Distante MA, L'Abbate A: Efficacy of isosorbide‐5‐mononitrate versus nifedipine in preventing spontaneous and ergonovine‐induced myocardial ischaemia: A double‐blind, placebo‐controlled study. Eur Heart J 1993; 14: 845–851 [DOI] [PubMed] [Google Scholar]
  • 28. Chahine RA, Feldman RL, Giles TD, Nicod P, Raizner AE, Weiss RJ, Vanov SK: Randomized placebo‐controlled trial of amlodipine in vasospastic angina. J Am Coll Cardiol 1993; 21: 1365–1370 [DOI] [PubMed] [Google Scholar]
  • 29. Morikami Y, Yasue H: Efficacy of slow‐release nifedipine on myocardial ischemic episodes in variant angina pectoris. Am J Cardiol 1991; 68: 580–584 [DOI] [PubMed] [Google Scholar]
  • 30. Winniford MD, Johnson SM, Mauritson DR, Rellas JS, Redish GA, Willerson JT, Hillis LD: Verapamil therapy for Prinzmetal's variant angina: Comparison with placebo and nifedipine. Am J Cardiol 1982; 50: 913–918 [DOI] [PubMed] [Google Scholar]
  • 31. Ardissino D, Savonitto S, Mussini A, Zanini P, Rolla A, Barberis P, Sardina M, Specchia G: Felodipine (once daily) versus nifedipine (four times daily) for Prinzmetal's angina pectoris. Am J Cardiol 1991; 68: 1587–1592 [DOI] [PubMed] [Google Scholar]
  • 32. Schroeder JS, Feldman RL, Giles TD, Friedman MJ, DeMaria AN, Kinney EL, Mallon SM, Pitt B, Meyer R, Basta LL, Curry C, Groves B, MacAlpin RN: Multiclinic controlled trial of diltiazem for Prinzmetal's angina. Am J Med 1982; 72: 227–232 [DOI] [PubMed] [Google Scholar]
  • 33. Waters DD, Bouchard A, Théroux P: Spontaneous remission is a frequent outcome of variant angina. J Am Coll Cardiol 1983; 2: 195–199 [DOI] [PubMed] [Google Scholar]
  • 34. Scholl JM, Veau P, Benacerraf A, Brau J, Hennetier G, Achard F: Long‐term prognosis of medically treated patients with vasospastic angina and no fixed significant coronary atherosclerosis. Am Heart J 1988; 115: 559–564 [DOI] [PubMed] [Google Scholar]
  • 35. Walling A, Waters DD, Miller DD, Roy D, Pelletier GB, Théroux P: Long‐term prognosis of patients with variant angina. Circulation 1987; 76: 990–997 [DOI] [PubMed] [Google Scholar]
  • 36. Yasue H, Takizawa A, Nagao M, Nishida S, Horie M, Kubota J, Omote S, Takaoka K, Okumura K: Long‐term prognosis for patients with variant angina and influential factors. Circulation 1988; 78: 1–9 [DOI] [PubMed] [Google Scholar]
  • 37. Fukai T, Koyanagi S, Takeshita A: Role of coronary vasospasm in the pathogenesis of myocardial infarction: Study in patients with no significant coronary stenosis. Am Heart J 1993; 126: 1305–1311 [DOI] [PubMed] [Google Scholar]
  • 38. MacAlpin RN: Cardiac arrest and sudden unexpected death in variant angina: Complications of coronary spasm that can occur in the absence of severe coronary stenosis. Am Heart J 1993; 125: 1011–1017 [DOI] [PubMed] [Google Scholar]
  • 39. Myerburg RJ, Kessler KM, Mallon SM, Cox MM, DeMarchena E, Interian A, Castellanos A: Life‐threatening ventricular arrhythmias in patients with silent myocardial ischemia due to coronary artery spasm. N Engl J Med 1992; 326: 1451–1455 [DOI] [PubMed] [Google Scholar]
  • 40. Gabliani GI, Winniford MD, Fulton KL, Johnson SM, Mauritson DR, Hillis LD: Ventricular ectopic activity with spontaneous variant angina: Frequency and relation to transient ST segment deviation. Am Heart J 1985; 110: 40–43 [DOI] [PubMed] [Google Scholar]
  • 41. Hillis LD, Braunwald E: Coronary artery spasm. N Engl J Med 1978; 299: 695–702 [DOI] [PubMed] [Google Scholar]
  • 42. Shubrooks SJ, Bete JM, Hutter AM Jr, Block PC, Buckley MJ, Daggett WM, Mundth ED: Variant angina pectoris: Clinical and anatomic spectrum and results of coronary bypass surgery. Am J Cardiol 1975; 36: 142–147 [DOI] [PubMed] [Google Scholar]
  • 43. David PR, Waters DD, Scholl JM, Crepeau J, Szlachcic J, Lespérance J, Hudon G, Bourassa MG: Percutaneous transluminal coronary angioplasty in patients with variant angina. Circulation 1982; 66: 695–702 [DOI] [PubMed] [Google Scholar]

Articles from Clinical Cardiology are provided here courtesy of Wiley

RESOURCES