Does variant angina (Prinzmetal's angina) only occur during physical activity and last approximately 5 minutes?

From the Guidelines

No, primeval angina (also known as variant angina or vasospastic angina) does not only occur during physical activity and does not typically last about 5 minutes. Unlike typical angina, primeval angina usually occurs at rest, often during the night or early morning hours, and is not triggered by physical exertion or emotional stress. Episodes typically last from 5 to 30 minutes, not just 5 minutes. This condition is caused by spasm of the coronary arteries rather than blockage due to atherosclerosis. The pain is often more severe than with typical angina and may be accompanied by arrhythmias or even heart attack.

Key Points

• Primeval angina is a type of angina that occurs at rest, not just during physical activity 1.
• Episodes of primeval angina can last from 5 to 30 minutes, not just 5 minutes 1.
• Treatment usually involves calcium channel blockers such as diltiazem (180-360 mg daily) or amlodipine (5-10 mg daily) and long-acting nitrates like isosorbide mononitrate (30-120 mg daily) 1.
• Patients should avoid triggers like smoking, alcohol, and cocaine, which can precipitate coronary spasm 1.
• If you experience chest pain at rest, especially if severe or prolonged, seek immediate medical attention as this could indicate a serious cardiac condition 1.

From the Research

Characteristics of Primeval Angina

• Primeval angina, also known as variant angina or Prinzmetal's angina, is a form of angina pectoris that occurs at rest or with minimal exertion, rather than solely during physical activity 2, 3, 4.
• The episodes of chest pain are usually transient, but the duration is not strictly limited to 5 minutes, and can vary depending on the individual and the severity of the coronary artery spasm 3, 4.
• The pain is often accompanied by ST-segment elevation on an electrocardiogram, which can be used to diagnose the condition 3, 4.

Triggers and Risk Factors

• Primeval angina is often triggered by coronary artery spasm, which can be caused by a variety of factors, including endothelial dysfunction, enhanced vascular smooth muscle contractility, and imbalance in autonomic nervous activity 2, 3, 5.
• The condition is more common in women and can be associated with other vasospastic disorders, such as Raynaud's phenomenon and migraine headaches 2, 4.
• Cigarette use is also a risk factor for primeval angina, and patients may not have the classical cardiovascular risk factors 4.

Diagnosis and Treatment

• The diagnosis of primeval angina is typically made by observing transient ST-segment elevation during an attack of angina, and can be confirmed with provocative testing, such as the administration of ergonovine intravenously 4.
• Treatment for primeval angina usually involves the use of vasodilator drugs, such as nitrates and calcium channel blockers, which can help to relieve the coronary artery spasm and prevent future episodes 2, 3, 5, 4.
• Beta-blockers and large doses of aspirin are generally contraindicated in primeval angina, as they can worsen the condition 4.