Cause of pain:Angina is the name given to chest pain or chest discomfort caused by ischemia (oxygen starvation) of the cardiac muscle. Coronary artery spasm (also called Prinzmetal's angina) is a condition in which ischemia results from spasm in the the coronary arteries. The narrowed artery is incapable of delivering the necessary blood volume to the working muscle.
Characteristics of pain:Angina can be quite variable, but classically is described as a pressure-like, squeezing, crushing, or tight pain. Some patients with angina deny pain at all, but agree when the term "discomfort" is described to them. The discomfort often radiates to the jaw, shoulders or arms. It can be accompanied by nausea, sweating, shortness of breath, dizziness, weakness, or fatigue. While classical angina is often provoked in a predictable manner by exercise, anger, or a large meal, coronary artery spasm can occur at any time, and most often occurs at rest and without any obvious provocation.
Evaluation:The evaluation of angina includes a careful medical history and physical examination, which often point to the diagnosis. Testing always includes an ECG, and often a stress test or a cardiac catheterization. Coronary artery spasm should be suspected if the character of the pain and ECG changes are suggestive of angina, but the coronary arteries are normal on catheterization. If spasm is being considered, special steps should be taken during the catheterization to attempt to provoke spasm, thus documenting its presence.
Bory, M, Pierron, F, Panagides, D, et al. Coronary artery spasm in patients with normal or near normal coronary arteries. Long-term follow-up of 277 patients. Eur Heart J 1996; 17:1015.