Harvard Heart Letter

Ask the doctor: What is Prinzmetal's angina?

Q. A doctor recently told my wife that she might have Prinzmetal's angina. What is this condition, and how is it treated?

A. Prinzmetal's angina is an older term for a type of chest pain more commonly known as a coronary artery spasm—a tightening of the muscles within the arteries of the heart. These brief, temporary spasms block blood flow to heart muscle, triggering chest pain. It's similar to angina that happens to people with cardiovascular disease whose arteries are clogged with cholesterol-laden plaque. But while people who have coronary spasms may have some arterial plaque, their arteries may be completely clear.

Coronary artery spasms occur unpredictably, up to several times a day. Unlike typical angina, the symptoms do not always happen during or after physical activity. Diagnosis is tricky: the person has to take a drug to provoke a spasm and then undergo a coronary angiogram, an X-ray image of the heart's arteries. As a result, doctors often simply treat people whom they suspect have the condition with nitroglycerin and calcium-channel blockers—the same medications many people take for typical angina.

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