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Ask the doctor: What is vasospastic angina?

Ask the doctor

What is vasospastic angina?

Q. I sometimes get excruciating chest pain out of the blue — almost never when I am exercising or doing something physical — that gradually goes away by itself. My doctor calls it vasospastic angina. Can you give me more information?

A. Your chest pain comes from sudden constrictions of a coronary artery. These spasms narrow the artery and temporarily stop blood flow to part of the heart. The pain you feel is the heart's response to lack of oxygen and nutrients and the buildup of waste products. It's akin to a muscle cramp in your leg, and is the same sensation felt by people with classic angina.

Vasospastic angina isn't rare. It affects up to 3 in 100 people who have an angiogram to look for a cause of their chest pain.

The big difference between classic angina and what you have is that classic angina is usually triggered by physical exertion. As you described, vasospastic angina (also called variant angina or Prinzmetal angina) can happen when you are resting. Some people have a mixture of both classic and vasospastic angina.

Most people with classic angina have cholesterol-narrowed arteries. That's not necessarily the case for people with vasospastic angina, who often have normal-looking coronary arteries. This can present a problem, since they are sometimes told there is nothing wrong with them after an angiogram shows seemingly clear arteries. Two drugs, ergonovine and acetylcholine, which can provoke coronary artery spasm, are sometimes used to diagnose this condition. Exposure to cold and hyperventilation can also induce spasms.

Blood vessel spasms Sudden contractions of a coronary artery can dramatically slow, or even temporarily stop, blood flow to part of the heart. This can cause chest pain that feels like classic angina, but isn't triggered by exertion or stress.

Nitroglycerin is almost always successful in relaxing the constricted artery and easing the chest pain it causes. Long-acting nitrates and calcium-channel blocking agents, such as nifedipine (Procardia) and amlodipine (Norvasc), are useful for preventing attacks. Smoking contributes to vasospasm, so stopping smoking is essential. And you might want to avoid taking a nonselective beta blocker, such as propranolol (Inderal), since these drugs can prolong episodes of vasospasm.

As frightening as the episodes may be, vasospastic angina is less likely to lead to a heart attack than the angina caused by atherosclerosis (cholesterol-clogged arteries). That's because most heart attacks are caused by the rupture of an atherosclerotic plaque. This doesn't mean vasospastic angina is benign, since many people with it have some (or substantial) atherosclerotic plaque, and some develop potentially dangerous arrhythmias during episodes of pain.

— Thomas Lee, M.D. Editor In Chief, Harvard Heart Letter

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Last updated:	November 07, 2006