Updated January, 2006
Prinzmetal's Angina, or coronary artery spasm, is an uncommon condition seen in both men and women. Episodes of typical (though severe) angina are triggered when one of the major coronary arteries suddenly goes into spasm, temporarily shutting off blood flow. These episodes are accompanied by major changes on the ECG. Because the spasm almost always terminates spontaneously, it is uncommon (though possible) for a heart attack to occur. But during the period of spasm itself, the oxygen-starved heart muscle can trigger dangerous and potentially fatal heart arrhythmias. The spasm is usually relieved promptly by nitroglycerin.
As opposed to typical angina, Prinzmetal's Angina usually occurs during periods of rest, most often in the early morning hours. Frequently, episodes appear in clusters. While in men Prinzmetal's angina is often associated with typical CAD, in women it is not. Women with Prinzmetal's tend to have few risk factors for CAD, though many have a history of migraine headaches (another condition associated with arterial spasm.)
Exercise testing and routine coronary angiography usually give normal results. The most definitive way to make the diagnosis is by administering ergonovineduring angiography. Ergonovine triggers coronary artery spasm in susceptible patients, clinching the diagnosis. Treatment with calcium channel blockers or nitrates eliminates spasm in most of these patients. Once adequately treated, their prognosis is good
