Diagnosis Criteria for Variant Angina

Variant angina, also known as Prinzmetal's angina, is typically diagnosed based on specific clinical features. One of the primary indicators is the occurrence of chest pain at rest. This is often linked to transient ST-segment elevation observed on an electrocardiogram (ECG). Patients diagnosed with this condition are usually younger and may have a history of smoking, alcohol consumption, or even drug use—especially substances like cocaine—which can trigger coronary artery spasms leading to angina.

Key Diagnostic Features

Unlike typical angina, which often occurs during physical exertion, variant angina tends to happen during periods of rest, usually in the early morning hours. The chest pain experienced can be quite severe but often resolves spontaneously. Following an episode, both the ECG and coronary angiography usually appear normal, which helps differentiate this condition from other forms of angina caused by fixed blockages in the coronary arteries.

Diagnostic Tests and Evaluation

Confirming the diagnosis may involve provocative testing with agents like acetylcholine or ergonovine to induce coronary spasm under controlled conditions. These tests are particularly useful when the clinical suspicion is high but the ECG findings are inconclusive. Continuous ECG monitoring and stress testing may also be employed to rule out other cardiac conditions.

Management and Treatment

Lifestyle modifications play a crucial role in managing variant angina. Patients are strongly advised to quit smoking and avoid excessive alcohol consumption, as these habits are closely associated with coronary spasm triggers. Medications such as calcium channel blockers (e.g., diltiazem) and nitrates are commonly prescribed to prevent spasms and reduce the frequency of angina episodes.

Important Considerations in Treatment

It is essential to avoid beta-blockers such as metoprolol in the treatment of variant angina. Although these medications are effective for other types of angina, they can potentially worsen coronary spasms in this specific condition. Therefore, careful selection of pharmacological therapy is vital to ensure patient safety and optimal outcomes.