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Vasospastic angina - Causes, Symptoms & Treatments

Image shows a coronary artery supplying blood and oxygen to your heart going into spasm and suddenly narrowing.

Vasospastic angina is a type of angina (chest pain) that usually occurs at rest – often in the early morning or at night - and feels like a constriction or tightening in the chest.

 

Vasospastic angina is also known as prinzmetal angina, variant angina or coronary artery spasm. It develops when a coronary artery supplying blood and oxygen to your heart goes into spasm and suddenly narrows. 

 

People experiencing vasospastic angina do not typically have episodes of angina during exercise. If you have coronary artery disease (a build-up of fatty deposits called atherosclerosis in the coronary arteries), this can make the condition worse. 

Vasospastic angina can also occur alongside microvascular angina, a condition that affects the tiny arteries within the heart muscle that play a crucial role in regulating blood supply to the heart. 

Vasospastic angina is an under-diagnosed condition that tends to affect men and women over the age of 50, but younger people can also suffer from the condition.  

What are the symptoms of vasospastic angina?

Some people feel the pain or discomfort in their chest, arm or jaw. The pain:

  • usually occurs while at rest and in the early morning or late at night
  • is often severe, but can be variable and can also be mild (a sense of unease)
  • can occur in other locations in the body; the back, shoulders, neck, stomach and arms
  • can be eased through taking medication
  • some people can also experience nausea.

The spasm can come in ‘clusters’ of two or three. If the spasm is persistent it can lead to an abnormal heart rhythm, for which you may need treatment, or in rare instances a heart attack.

What are the causes of vasospastic angina?

We don’t yet know what causes vasospastic angina, but we do know that the following are often triggers:

  • emotional stress
  • exposure to extremely cold weather or a sudden drop in temperature
  • hyperventilation
  • allergic reactions (usually severe reactions that result in histamine release, sometimes referred to as  Kounis Syndrome)
  • inflammation of the coronary artery wall
  • smoking
  • some antidepressants
  • some anti-migraine drugs
  • use of the drug cocaine
  • high consumption of alcohol
These triggers may also make the symptoms of vasospastic angina worse and increase the number of angina attacks experienced. You should also check with your specialist if any other medications or supplements you take routinely could have an adverse impact on your condition. 

How is vasospastic angina diagnosed and treated?

You may need a number of tests to diagnose vasospastic angina, including:

  • ECG (ideally taken at the time of chest pain)
  • ECG while doing light exercise, such as walking 
  • coronary angiogram (with an injection of Acetylcholine, a chemical that can ‘provoke’ tightening and spasm of the blood vessel during the procedure, thus revealing  providing the diagnosis in some patients).

Vasospastic angina is a chronic condition that will need to be monitored by your cardiologist, specialist nurse or GP. It can also present with acute episodes leading to hospital admission for administration of intravenous nitrates, and in some instances, intravenous morphine for pain relief.

The treatment for vasospastic angina is with sublingual nitrates or GTN spray, which in most cases relieves symptoms promptly. 
You may also be given a calcium channel blocker, such as Verapamil, Amlodipine or Diltiazem, to help prevent or reduce the number of spasms.
All of these medications relax the coronary arteries to allow more blood to flow through. You should check with your specialist which medications are suitable for you (including when and how often they should be taken).

How do I manage vasospastic angina?

It’s important to recognise any triggers that may be affecting your symptoms, and to keep a diary of these so you can let your doctor know. 

You mainly manage vasospastic angina with medication, which is very effective in most cases. As with all heart and circulatory conditions, managing your lifestyle in the following ways can also help control your symptoms:

What is the outlook for someone living with vasospastic angina?

For some people, vasospastic angina appears and then goes away after some years. For other people it persists for many years. 

When living with vasospastic angina it is important to find the right exercise and support for you as an individual. Talk to your specialist about the right exercise for you.

What is my target heart rate?

Target heart rate is an important figure for you to know as it enables you to exercise at a suitable level without placing any unnecessary strain on your heart and causing discomfort. Your target heart rate (THR) is between 50% and 70% of your maximum heart rate. You should aim to exercise with your heart rate between these two figures.

If you have a heart condition, check with your doctor before doing any new exercises, in case they aren’t suitable. You should also warm up and cool down before and after exercising to avoid injury to your muscles.

Our target heart rate tool helps you discover what your target heart rate should be.

Try it now

 

You may need referral from your specialist or GP to your local Pain Management Service for chronic pain management and further advice regarding specific techniques or equipment (e.g. TENS machine) to help relieve symptoms. 

Living with vasospastic angina can, for some, also lead to anxiety, depression and in some cases Post Traumatic Stress Disorder (PTSD), and you may need referral for psychological support from your specialist or GP. 

Angina booklet

This booklet is for people with angina, and for their friends and family. It explains what angina is, what causes it, how angina is diagnosed, and what can be done to treat the condition. It also explains what to do if you get an episode of angina, or if you think you may be having a heart attack.

Order or download now

This booklet is also available to download in large print, and in Welsh

For more help and information: