Prinzmetal’s variant angina is caused by coronary artery spasm of undetermined etiology. Pain usually occurs at rest as opposed to typical stable angina occurring during exertion. The ECG during pain shows ST-segment elevation as opposed to typical angina showing ST-segment depression. An ECG is not necessary, however, to initiate therapy.
Beta-blockers can increase coronary artery spasm and cause chest pain so they are contraindicated in these patients. Management includes cessation of smo¬king, avoidance of aspirin that may cause spasm, and the use of high doses of nitroglycerin and calcium antagonists. Unfortunately patients with variant angina, even when the syndrome is completely controlled by calcium antagonists, have died or have had myocardial infarctions. Although calcium antagonists are efficient in controlling the pain of coronary artery spasm, they do not prevent death. Coronary artery bypass surgery is indicated in patients with significant atheromatous coronary artery obstruction, which occurs coincidentally in some patients with variant angina.