Prinzmetal's Variant Angina is a very rare and serious cardiac disease that has two different variations. One where the arteries of the heart are completely normal, and one where the arteries have some occlusion. Both types are caused by spasms in the major arteries, with the result that the vessel contracts. The blood flow to the heart muscle stops, and the result is heart cramps, also called angina pectoris.

Patients with Prinzmetal's Variant Angina often have a tendency to migraine and some also have Raynauds Syndrome.

Why some people develop Prinzmetal's Variant Angina is unknown. In 1996 there was an experiment done at the Toyama Medical and Pharmaceutical University in Japan. They were looking for a possible connection between the lack of vitamin E and Prinzmetal's Variant Angina (You can read the article here). This theory was not confirmed, however it did show that there was a tendency in patients with Prinzmetal's Variant Angina to have a high level of cholesterol. More specifically a high level of LDL cholesterol. As far as I know there has not been any further research in this. So this is just a theory that is unconfirmed.

How does it feel?

It varies from patient to patient, but generally it's shortness of breath and the feeling of pressure on the chest. At times a painful pressure related to a lack of oxygen in the heart muscle. The pain often goes up into the neck, towards the shoulders and sometimes even out to the arms.

Women's symptoms can be somewhat difficult to interpret and is more diffuse, but they must be taken seriously. Symptoms can occur alone or several at the same time. They can come, and go, and then come back and they need not be accompanied by pain. Symptoms may arise from psychological stress or physical activity. Symptoms in women can be:

• Discomfort in the chest region - an oppressive or tightening sensation
• Breathlessness that can occur alone or together with the unpleasant tightness in chest
• Palpitations
• Dizziness, nausea or vomiting
• Sweat
• Pain / discomfort in both arms, between the shoulder blades, neck and jaw
• Unusual tiredness
• Sleep disorders
• Digestive Problems and / or a painful sensation of gas
• A feeling that something is quite wrong

What can trigger an attack?

Several things can trigger an attack when you have Prinzmetal's Variant Angina. Cold weather, a big meal, physical and psychological stress, smooking, and some times they can come completely unprovoked. It's not unusual for the patient to have a attack while at rest, rather then when moving. If it's a severe spasm, it is possible that a heart attack can occur.

Treatment of Prinzmetal Variant Angina?

Patients with Prinzmetal's Variant Angina are often treated with calcium channel blockers, nitroglycerin tablets and Nitromex for an acute attack. These can relieve the symptoms of chest pain and lessen the frequency of painful episodes. In severe cases it may be necessary to give morpine, but it's usually only something that is being used as a last resort.

But one has to realise that the purpose with the medical treatment is to relieve the symptoms, because at this time there does not exist a cure for prinzmetal variant angina.

If you are a smoker and have Prinzmetal Variant Angina

Smoking can provoke angina attacks, so it is strongly recommended that as a patient with Prinzmetal Variant Angina you don't smoke.

But if you already are a smoker and want to stop, you must be very careful not to use nicotine products such as Nicorette. If you read the leaflet in these products is actually advise against the use of Nicorette to people with "Prinzmetal variant angina, unstable / stable angina." So there is no easy way for this group of people to quit smoking.

Your future if diagnosed with Prinzmetal's Variant Angina?

This is an area that doctors don't say much about. The fact is however that a lot of patients have problems doing their job, and some are even forced into an early retirement.

Fact is, however, that many because of pain and fatigue due to the Prinzmetal Variant Angina, find it difficult to maintain the life they had before the illness beginning. Some patients have great difficulty in coping with their work, and some are even forced into early retirement.

Prinzmetal…?

Prinzmetal's Variant Angina is named after the doctor that first noticed this cardiac disease, the American cardiologist Myron Prinzmetal (1908-87).

Prinzmetal's Variant Angina goes under many names, which only makes it even more confusing. Some of the names that Prinzmetal's Variant Angina goes by are:

• Prinzmetal's syndrome
• Prinzmetal's variant angina
• Prinzmetal's variant of angina pectoris
• Prinzmetal-Massumi syndrome
• Prinzmetal's angina
• Variant angina
• Angina inversa
• Coronary artery spasme

Are Prinzmetal's Variant Angina and Syndrome X the same?

No, they are not the same. The difference between Prinzmetal's Variant Angina and Syndrome X is in which vessels the angina is. With Prinzmetal's Variant Angina the angina occurs in the major arteries and with Syndrome X they occur in the smaller arteries on the heart. Another distinct difference is that Prinzmetal's Variant Angina can develop to a deadly disease, and cause heart failure. Where Syndrome X is not a deadly disease. Besides that, the symptoms and treatments are exactly the same.

Source: Hjerteforeningen
Note: Some of the used informations, are from a lecture by Hans Erik Bøtker, from May 2005.
This article was last updated on 03. October 2009

Read the German translation here: Prinzmetal Angina