Whenever we think chest pain, we think heart attack. And thats important, because any type of chest pain is a serious warning and should be evaluated by a physician immediately. But it could also be an unusual form of angina. A type that occurs at rest called variant angina.
Most of us have heard of angina, chest pain most commonly linked to heart attacks.
But did you know theres are several types of angina, including:
- Stable anginathis form has a predictable pattern. It generally occurs when a blocked artery causes reduced blood flow to the heart when the heart is working hard. Emotional stress or physical activity can make you heart work harder. As a result, stable angina appears when you are physically active or emotionally charged.
- Unstable anginathis type is more unpredictable or severe. It may be a sign that you are about to have a heart attack. It should be treated as an emergency.
- Microvascular anginathis is a recently discovered type of angina in which people have chest pain but no apparent coronary artery blockages. This type of chest pain is caused by problems in the tiny blood vessels that nourish the heart, arms, and legs.
- Variant anginathis form is characterized by a sudden, temporary narrowing or tightening of a coronary artery. Variant angina is also called coronary artery spasm, atypical angina, or Prinzmetals angina.
Most types of angina are caused by problems with blood vessels and are often triggered by either physical or emotional exertion. But variant angina is caused by spasm of one of the coronary arteries. It generally occurs when you are at rest, often between the hours of midnight and 8:00 am. It is rare, but can be very painful and frightening. What is Coronary Artery Spasm? Coronary artery spasm is a sudden, temporary narrowing or tightening of a small part of an artery. The artery supplies blood to the heart. This spasm results in the heart temporarily not getting enough blood. The blockage of blood causes you to feel chest pain. Coronary artery spasm can occur in people who do not have significant coronary artery disease. However, two thirds of people with variant angina have severe disease in at least one vessel. The spasm typically occurs at the site of blockage. Fortunately, coronary artery spasm does not typically trigger the series of events that can lead to a heart attack. However, if a coronary artery spasm is severe and occurs for a long period of time, a heart attack can occur. The cause of coronary artery spasm is unknown. In young people, coronary spasm is often related to the use of illicit drugs, particularly cocaine. It can also be triggered by emotional stress, exposure to cold, or heavy smoking, particularly in women. People who have underlying coronary artery disease, heart valve disease, hypertrophic cardiomyopathy (an enlarged heart due to disease), or uncontrolled high blood pressure are also at an increased risk of variant angina.
What are the Symptoms of Variant Angina? The symptoms of variant angina include: Chest pain that feels like a strangling or heavy pressure on the chestPain that starts in the chest and spreads to the throat, arms, (usually the left arm), and jaws, and between the shoulder blades; it can also spread to the stomach and feel like an ulcer or indigestionA feeling of tightness or heaviness in the chestNauseaSweatingLight-headednessTrouble breathingPalpitations (rapid or irregular heartbeats), skipped beats, or a flip-flop feeling in your chest How is Variant Angina Diagnosed? If your doctor suspects you have variant angina, he or she will examine you and order an electrocardiogram (ECG). The ECG will record your heart rhythms and may show certain changes indicating that your pain is being caused by coronary spasm. Your doctor may also ask you to wear a small, portable ECG recorder called a Holter monitor for 24 to 72 hours. Like an ECG, this monitor also records your hearts rhythms. In some cases, you may also be asked to take a stress or treadmill ECG. During this type of ECG, your hearts activity is recorded while you are under stress (ie, exercising). Your doctor may also order a panel of blood tests to determine whether any significant heart injury has occurred or is likely to occur.
Finally, your doctor may order a coronary angiogram, a special x-ray that uses a dye to create images of your arteries. This test can show your doctor any blockages in your arteries. During this test, you may actually be given a medicine designed to trigger a coronary spasm. This is done to help locate on the x-ray exactly where the spasm is occurring. How is Variant Angina Treated? Variant agnina is treated with drugs called calcium channel blockers. These drugs can decrease variant angina attacks, and are often used in combination with nitrates. Variant angina tends to be cyclic, meaning that it appears for a while and then goes away. This means that after 6-12 months of treatment, your doctor may be able to gradually reduce your medications. If, however, your angina is being caused by a severe blockage, your doctor may schedule a procedure called an angioplasty to treat it. The goal of treating variant angina is to stop the symptoms. Your doctor will work with you to come up with a plan that includes: Stopping the use of any drugs that cause coronary artery spasmTaking medication to help prevent coronary spasmReviewing your lifestyle and habits to reduce your risk for heart diseaseHaving frequent follow-up appointments to check your progressQuitting smoking
What Can You Do? Remember that many types of chest pain arent related to angina at all. For example, heartburn or inflammation of the lungs may also cause chest pain. However, there is no way for you, especially if you are at home and frightened, to distinguish one type of chest pain from another. Therefore, any chest pain you experience should be evaluated by a doctor immediately. However, if you have a history of variant angina, there are some things you can do to take care of yourself. These include: Avoiding drugs that cause coronary spasm.Take your medicine as directed by your doctor.Report any new or changing symptoms to your doctor right away.Learn how anxiety and stress affect you and develop methods to help you cope more effectively. RESOURCES: American Heart Association http://www.americanheart.org National Women's Health Information Center http://www.4woman.gov/ National Heart, Lung, and Blood Institute http://www.nhlbi.nih.gov CANADIAN RESOURCES: Canadian Cardiovascular Societyhttp://www.ccs.ca/home/index_e.aspx Heart and Stroke Foundation of Canadahttp://ww2.heartandstroke.ca/Page.asp?PageID=24
References Angina pectoris. American Heart Association website. Available at: http://www.americanheart.org/presenter.jhtml?identifier=4472. Accessed October 17, 2003. Angina pectoris treatments. American Heart Association website. Available at: http://www.americanheart.org/presenter.jhtml?identifier=4496. Accessed October 17, 2003. Coronary artery disease. The Merck ManualHome Edition website. Available at: http://www.merck.com/mrkshared/CVMHighLight?file=/mrkshared/mmanual_home/sec3/27.jsp%3Fregion%3Dmerckcom&word=chest&word=pain&domain=www.merck.com#hl_anchor. Accessed October 20, 2003. Coronary spasm. University of Michigan Health Center website. Available at: http://www.med.umich.edu/1libr/aha/aha_coronsps_crs.htm. Accessed October 17, 2003. Facts about angina. National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/public/heart/other/angina.htm. Accessed October 20, 2003. Theroux P, Waters D. Diagnosis and management of patients with unstable angina. In: Hursts The Heart. 9th ed. 1998;46:1333.
What are the symptoms of coronary artery disease? Cleveland Clinic Heart Center website. Available at: http://www.clevelandclinic.org/heartcenter/pub/guide/disease/cad/cadsymptoms.htm. Accessed October 20, 2003. Last reviewed March 2008 by Michael J. Fucci, DO Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.