What Is Variant Angina?

Understanding the Basics of Variant Angina

Variant angina, also known as Prinzmetal's angina, is a unique type of chest pain caused by a spasm in the coronary arteries. Unlike typical angina, which is often linked to physical exertion or emotional stress, this condition usually occurs at rest. It is most commonly experienced during the night or early morning hours, making it distinct from other forms of angina.

How Does Variant Angina Affect the Heart?

When a spasm occurs in the coronary arteries, it temporarily narrows the artery and reduces blood flow to the heart muscle. This leads to myocardial ischemia, or a lack of oxygen to the heart tissue. On an electrocardiogram (ECG), this condition typically shows a characteristic elevation in the ST segment of the ECG waveform, which is different from the ST depression seen in classic angina.

Key Differences from Other Types of Angina

One of the most notable features of variant angina is that it does not usually correlate with increased oxygen demand. In other words, it is not triggered by physical activity. Instead, it often occurs when the body is at rest, especially during sleep. This unique pattern helps doctors distinguish it from other types of chest pain.

Underlying Causes and Risk Factors

Most cases of variant angina are associated with underlying coronary artery disease. The arteries involved often show signs of endothelial dysfunction or atherosclerosis. These pre-existing conditions make the arteries more sensitive to various triggers, such as stress, cold exposure, or certain medications, which can lead to spasms.

Why the ECG Looks Different

Because the spasm affects the heart's outer layer (epicardium), the ECG shows ST-segment elevation — a pattern similar to what is seen in a heart attack. However, unlike a heart attack, blood tests usually show normal levels of cardiac enzymes. That said, in severe cases, prolonged ischemia can occur, potentially leading to a heart attack.

Recognizing the Risks and Complications

Although variant angina can often be managed with medication, it carries a risk of serious complications. In some instances, the prolonged spasms can result in sustained myocardial ischemia, which may lead to myocardial infarction or even life-threatening arrhythmias. Therefore, timely diagnosis and treatment are essential to prevent adverse outcomes.