What is the pathophysiology of Prinzmetal's variant angina?
Diagnosis and treatment of Prinzmetal's variant angina The presentation, diagnosis (including provocative testing), and therapy of Prinzmetal's variant angina are reviewed. Prinzmetal's variant angina (PVA) is a form of angina caused by coronary-artery vasospasm (CAS) and is not associated with exertion.
What drugs are used to treat Prinzmetal angina?
The types of drugs used to treat Prinzmetal angina include: Nitrates: These can be given in sublingual tablets, oral tablets or capsules or patches. Calcium channel blockers: These include diltiazem, amlodipine, nifedipine and verapamil.
When can I stop taking Prinzmetal for angina?
After six to 12 months of treatment, doctors may gradually reduce the medication. Prinzmetal's angina is a chronic condition that will need to be followed by your healthcare provider even though the prognosis is generally good. Track your angina symptoms with our Angina Log.
What is variant angina (vasospastic angina)?
Vasospastic angina, variant angina, or Prinzmetal angina is a known clinical entity characterized by chest pain at rest with transient ischemic electrocardiographic changes in the ST segment, with a prompt response to nitrates. These symptoms are attributed to coronary arteries spasm.[1][2] NCBI Skip to main content
What is the treatment for prinzmetal angina?
Drugs such as calcium antagonists and nitrates are the mainstays of treatment. The spasms tend to come in cycles – appearing for a time, then going away. After six to 12 months of treatment, doctors may gradually reduce the medication.
Which drug is contraindicated in variant angina?
Beta Blocker Use: BETA BLOCKERS are considered INEFFECTIVE, or CONTRAINDICATED for VARIANT (VASOSPASTIC) ANGINA (it may worsen such attacks by blocking some β2 receptors that produce vasodilator effects, leaving α-mediated effects unopposed (Figure 8)(Robertson et al, 1982).
What is the treatment for variant angina?
Variant angina is often treated with medications called calcium channel blockers. These medications can decrease variant angina attacks and are often used in combination with nitrates during attacks.
Why are beta-blockers not used for prinzmetal angina?
The use of beta-blockers, especially those with nonselective adrenoceptor blocking effects, should be avoided because these drugs can aggravate the symptoms. Treatment with guanethidine, clonidine, or cilostazol has been reported to be beneficial in patients taking calcium channel antagonists.
Can you use beta blockers in variant angina?
Beta-blockers can increase coronary artery spasm and cause chest pain so they are contraindicated in these patients.
What is prinzmetal's variant angina?
Prinzmetal (or Prinzmetal's) angina is also called variant angina, angina inversa and vasospastic angina. Angina is the term used to describe chest pain caused by inadequate blood flow to the heart muscle, usually caused by coronary artery disease.
Does nitroglycerin help variant angina?
Attacks of variant angina usually respond promptly to sublingual administration of short-acting nitrates (nitroglycerin, 0.3 to 0.4 mg, or isosorbide dinitrate, 5 to 10 mg), which may be repeated after 3 to 5 minutes if pain persists.
Which classes of drugs are used in the treatment of angina pectoris?
Nitrates or beta blockers are usually preferred for initial treatment of angina, and calcium channel blockers may be added if needed. The number and type of medications used are often tailored to how frequently angina occurs in an average week.
Are calcium channel blockers used for angina?
Calcium channel blockers are a heterogeneous group of compounds used in a variety of cardiovascular disorders such as stable angina pectoris, vasospastic angina, hypertension, hypertrophic cardiomyopathy, and supraventricular arrhythmias.
What causes Prinzmetal angina?
Prinzmetal angina, or variant angina, is caused by such a spasm in a coronary artery. These spasms can produce ischemia (oxygen starvation) in the part of the heart muscle supplied by the affected artery, and the symptoms of angina follow.
Which condition is a contraindication to the administration of a beta blocker for the treatment of angina?
Contraindications for β-blockers administration are: hypotension (systolic blood pressure < 100 mmHg), bradycardia (heart rate < 50 bpm), phenomenon Raynaud, severe pneumonopathy (especially chronic obstructive and bronchial asthma), and severe renal insufficiency.
Is bisoprolol used for angina?
Bisoprolol is one of the most widely used beta blockers (BB) for the relief of angina in patients with chronic coronary syndrome.
What is the best test for PVA?
Provocative tests, such as the cold-pressor test or intravenous ergonovine maleate, are sometimes used to aid diagnosis of PVA. Nitrates, adrenergic - blocking agents, and calcium-channel blocking agents can be used in treating PVA. Nitroglycerin and isosorbide dinitrate effectively relieve CAS.
What is the treatment for PVA?
Dosing guidelines for all drugs are given in the paper. Treatment of PVA should begin with oral nitrates.
What is PVA in medical terms?
Prinzmetal's variant angina (PVA) is a form of angina caused by coronary-artery vasospasm (CAS) and is not associated with exertion. It is diagnosed by history, electrocardiogram, or coronary-artery angiography. Provocative tests, such as the cold-pressor test or intravenous ergonovine maleate, are sometimes used to aid diagnosis of PVA.
What are the other calcium channel blockers?
Other calcium-channel blockers, including perhexilene maleate, diltiazem hydrochloride, prenylamine, and lidoflazine, have been tested in a few CAS patients with some success; adverse effects and toxicities limit the use of some of them, especially perhexilene .
Does Verapamil hydrochloride cause arrhythmias?
Side effects are mild and do not usually require termination of therapy. Verapamil hydrochloride, the prototype calcium-channel blocking agent for arrhythmias, is effective for PVA, but only 10-20% of an orally administered dose reaches systemic circulation because of the first-pass effect.
Does Nitroglycerin help with PVA?
Nitroglycerin and isosorbide dinitrate effectively relieve CAS. However, long-term prospective studies on the use of these drugs for PVA are lacking in the literature. Studies on treating PVA with adrenergic-blocking agents have been equivocol, with some studies reporting improvement and some reporting worsening.
Is nifedipine a good antianginal drug?
Calcium-channel blocking agents are promising drugs for PVA. Nifedipine is generally considered the prototype of this class for antianginal activity. It is administered orally in PVA patients and is effective. Side effects are mild and do not usually require termination of therapy.
When does Prinzmetal angina occur?
Unlike typical angina – which is often triggered by exertion or emotional stress – Prinzmetal’s angina almost always occurs when a person is at rest, usually between midnight and early morning. These attacks can be very painful.
What are the different types of angina?
Prinzmetal angina may also be referred to as: 1 Variant angina 2 Prinzmetal's variant angina 3 Angina inversa
How long does it take for Prinzmetal to stop working?
After six to 12 months of treatment, doctors may gradually reduce the medication. Prinzmetal's angina is a chronic condition that will need to be followed by your healthcare provider even though the prognosis is generally good. Track your angina symptoms with our Angina Log.
Why does my angina hurt?
Causes of Variant (Prinzmetal) Angina: The pain from variant angina is caused by a spasm in the coronary arteries (which supply blood to the heart muscle). The coronary arteries can spasm as a result of: Exposure to cold weather. Stress.
Is Prinzmetal's angina rare?
Angina inversa. Prinzmetal’s angina is rare, representing about two out of 100 cases of angina, and usually occurs in younger patients than those who have other kinds of angina.