Prinzmetal angina – Symptoms, Causes and Treatment

Prinzmetal angina Definition

Prinzmetal angina is a rare condition that is characterized by chest pain occurring in cycles. The condition is also known as Prinzmetal’s angina (PA), Angina Inversa or Variant Angina.

The term “Angina” refers to a heart condition marked by sudden attacks (paroxysms) of chest pain caused by decreased flow of oxygen to the heart. Prinzmetal angina is the rarest type of Angina.

Prinzmetal Angina ICD 9 Code

The ICD 9 Code for Prinzmetal Angina is 413.1.

Prinzmetal angina Symptoms

The most common symptoms of Prinzmetal angina are:

  • Chest pain
  • Tightness in chest
  • Heaviness in chest
  • Nausea
  • Sweating
  • Loss of consciousness
  • Respiratory difficulties
  • Arm pain

People suffering from PA usually experience a severe, crushing pain in their chest. The pain usually arises at night, when the person is sleeping and lying in a supine position. The pain is often described by patients as a tight, heavy sensation in the chest. The pain is usually experienced just beneath the chest bone. It may radiate to the neck, shoulders and arms.

The duration of pain and discomfort varies from one individual to another. In some people, it may last for a few seconds while it may last a few minutes in others. Severe pain may make a patient pass out. In some people, the sharp chest pain may other symptoms, such as respiratory shortness, nausea and pain in other parts of the body. Muscular spasms can also occur in some cases. An increase in their intensity and frequency can even cause a heart attack.

When Do Prinzmetal angina occur?

Normally, attacks of Prinzmetal angina occur when a person is at rest and is not involved in any activity that requires extreme physical exertion. This is unlike other types of Angina that typically occur when an individual is involved in some strenuous activity.

Prinzmetal angina Causes

The causes of Prinzmetal angina are not fully known. Certain contributing factors are believed to be

Defective arterial lining

Problems with the endothelium, or the thin lining of the blood vessels, are supposed to be contributory factors to this condition. The artery lining gives rise to a chemical known as Nitric Oxide that helps expand the blood vessel making it easier for blood to flow through them. Damage or improper functioning of the arterial lining can lead to a narrowing of the blood vessels and result in a coronary spasm.

Injured arterial lining

If the lining of the arteries suffer an injury, the muscle may get exposed to chemicals that lead to a narrowing of the blood vessels.

Defective nervous system

PA can also occur if problems arise in part of the nervous system. A defective nervous system can hinder blood flow and immediately give rise to chest pain.

Changes in muscle tissue structure

The condition may also originate in case the muscular tissue involved in manufacture of the arteries get too wide or too narrow.

Prinzmetal angina Diagnosis

The diagnosis of Prinzmetal’s angina requires taking a number of factors into consideration even though the symptoms of the condition are very characteristic. It is important to study the pattern of attacks and ensure that they occur only at night or during rest to rule out other types of angina, such as Angina Pectoris. Along with consideration of the signs and symptoms, certain other medical investigations need to be carried out. These include tests like,

  • Full blood count
  • Platelet count
  • Cardiac enzyme tests
  • ECG

A combination of all these examinations can help in making a complete diagnosis of this syndrome.

Prinzmetal Angina Treatment

There is no fixed treatment for Prinzmetal angina. Treatment offered for this medical syndrome aims at preventing the duration, intensity and frequency of the attacks. Usually, an individual getting an attack of PA is administered Sublingual Nitroglycerine that provides an almost instant relief.

Controlling the symptoms of the condition involves use of medications that aim at reducing spasm in the arteries. Drugs, such as long-acting nitrates, Nitroglycerin (NTG) and Calcium Channel Blockers, help widen or open the constricted blood vessels.

Individuals suffering from Coronary Artery Disease require additional treatment that may include Coronary Artery Bypass surgery or Angioplasty.

In some cases, individuals suffering from recurrent and severe attacks of PA may even require hospitalization.

Prinzmetal Angina Natural Treatment

Natural treatment for PA sufferers require long-time cure that involves lifestyle and dietary modifications. These include

  • Regular exercise
  • Cessation of smoking
  • Lowering cholesterol levels
  • Eating fresh healthy fruits

Following all these can greatly help in prevention of any more attacks in future.

Prinzmetal Angina and Beta Blockers

A large category of medicines, known as Beta blockers, are used to cure chest pain and cardiac disorders. These medications affect the response of certain bodily nerve impulses, particularly those of the coronary arteries and the heart. Beta blockers help keep heart rate low and expand blood vessels to help increase flow of blood to the heart. Beta blockers are quite useful in curing PA.

Prinzmetal Angina and Calcium Channel Blockers

Calcium channel blockers are also found to be effective in the treatment of Prinzmetal angina. These drugs curb the deposition of calcium in the coronary arteries and the heart. They also help relax the blood vessels and improve blood flow to the heart, thus providing relief from chest pain.

Prinzmetal Angina and Nitroglycerin

Nitroglycerin is a trusted medication for relieving PA problems. It helps cure heart disorders and ease chest pain. The medicine acts as a vasodilator and helps the vessels to open so as to assist flow of blood. Nitroglycerin comes in various forms such as tablets, pills, patches and sprays.

Prinzmetal Angina Prognosis

Usually, PA shows good response to Calcium Channel Blockers and Nitrates. If the sufferer shows a good response to medication, the prognosis can be very good. However, people suffering from more acute heart conditions have worse outcomes than those with less serious heart disorders or none at all. In individuals with Coronary Artery Disease, prognosis of this disorder is closely associated to its intensity. The intensity of the spasm and how much it obstructs blood flow to the heart may also help anticipate outcomes.

If you are suffering from chest pain, do not neglect it as it may indicate some dangerous underlying condition such as Prinzmetal angina. Get in touch with a cardiac specialist and find out whether you are having PA symptoms. Timely diagnosis and treatment will help you make a faster recovery from this extremely discomforting syndrome.


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