What Is Angina?
Angina is a medical condition where the person experiences unexplainable congestion and heaviness in and around the chest region. However, the patients may sometimes elicit associated discomfort, soreness, and weakness over the shoulder region, neck, arms, back, and lower jaw. Angina develops because of the remarkable collapse in the blood supply to the muscles that make up the heart (cardiac muscles). It can reflect other underlying heart disorders like coronary artery disease (a disease involving the blood vessel that nourishes the heart muscles).
Stable, unstable, and vasospastic angina are the three distinct forms of angina. Out of these, unstable angina is the deadliest, which often paves the way for heart attack (hindered blood flow to the heart). Angina indicates the heart's blood flow status and often helps promptly diagnose the underlying cardiac condition that otherwise would have gone unnoticed.
What Is Vasospastic Angina?
Vasospastic angina is quite an unfamiliar class of angina, where the pain attack does not necessarily need to be evoked by exertion or stress. Chest pain in vasospastic angina is encountered chiefly at night when the patient is in sound sleep. However, certain studies reported vasospastic angina upon strenuous activities, though the proportion could be more significant. Chest pain, which eventuates at rest, is considered the classic and conventional form of vasospastic angina. It is also known by the synonyms like prinzmetal angina, angina inversa and variant angina.
Adult populations, typically over 50 years, are vulnerable to developing vasospastic angina. Clinical studies have shown a strong gender preference for males. However, not much data is available concerning the prevalence of the condition.
How Does Vasospastic Angina Occur In?
As the name suggests, vasospastic angina is precipitated by contraction (spasm) of the blood vessels. The coronary artery is the blood vessel concerned with the blood supply to heart muscles. The smooth muscle envelopes and forms the walls of the blood vessels. So the contraction of the smooth muscle envelope brings about coronary artery spasms.
When the coronary artery contracts for some reason, the patent and consistent blood flow to the heart muscles get hindered or compromised, and the compromised blood flow triggers vasospastic angina, where the vascular spasm of the coronary blood vessels brings about angina.
The mechanism that brings in the contraction of the coronary artery has yet to be known to the medical field. One of the hypotheses suggests that the spasm develops due to exaggerated reactivity of the blood vessel musculature towards certain stimuli (triggering agent). The following are some of the widely reported triggering factors for coronary spasms:
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Cold climate.
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Emotional stress.
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Recreational drugs (cocaine, marijuana, alcohol, cannabis, and amphetamines).
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Insulin resistance (a metabolic condition where body cells fail to counteract insulin hormone).
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Antimigraine medications (Sumatriptan).
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Medications for hypotension (Ephedrine).
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Inflammation of blood vessels that nourishes the heart.
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Hyperventilation (over-breathing).
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Vasospastic disorders (disorders that elicit contraction of tiny blood vessels).
What Are the Symptoms of Vasospastic Angina?
Chest pain is the classic and hallmark presentation of any angina. In addition, vasospastic angina elicits a typical pattern in the pain attack, which often aids in the diagnosis process. The pain is experienced chiefly when the person is at rest. Nocturnal chest pain that typically develops during the early morning or midnight hours is the hallmark symptom of vasospastic angina.
The pain attack hardly lasts for five to ten minutes and then subsides. In certain patients, the angina attack lasts even less than a minute. However, the pain attack reflects a high recurrence with variable intensity. At times, the symptom-free period may even last for months.
Another distinguishing manifestation of vasospastic angina is that it does not respond with physical excretion. Vasospastic angina patients often tolerate physical activities and strenuous exercises without precipitating pain attacks.
During the pain attack, the person often gets drenched with sweat. In addition, the person may also experience severe weakness and dizziness. Sublingual nitrate tablets bring about prompt resolution of the pain attack, and immediate relief can be obtained upon medication.
How Is Vasospastic Angina Diagnosed?
Diagnosing vasospastic angina is challenging as it can be misunderstood as various other conditions because of overlapping symptoms. However, pain at night and rest often lead to the diagnosis on the right track. Hence detailed medical history and clinical findings are essential to establish the diagnosis.
An ambulatory electrocardiogram (ECG) is the mostly recommended diagnostic test for confirming the diagnosis of vasospastic angina so that the ECG recording during the pain attack can be obtained and assessed. Variation in the ECG recording is reflected only during the time of the angina attack. Sometimes the doctors may induce the precipitation of pain attacks with the help of agents that bring about coronary artery spasms to assess the ECG pattern, triggering factors, and response to nitrates.
Stress tests are also advised, which help to rule out other types of angina. Coronary angiography helps to give a clear picture of the coronary spasm that develops during the pain attack.
What Are the Treatment Interventions Available for Vasospastic Angina?
Treatment strategies for vasospastic angina are designed to reduce the incidence of pain attacks and to check the development of cardiac complications. The treatment modalities for vasospastic angina include the following:
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Calcium Channel Blockers: Calcium antagonists interfere with the availability of calcium ions, essential for initiating the tightening and spasm of the vascular smooth muscles. Calcium channel blockers bring about the widening and relaxation of the coronary vascular smooth muscles and thereby help in tackling vasospastic angina attacks. These are considered to be the standard treatment approach for vasospastic angina. Verapamil, Amlodipine, and Diltiazem are the widely prescribed calcium antagonists for vasospastic angina. Patients who fail to elicit proper response towards calcium channel blockers are given a combination of two different calcium channel blocker drugs.
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Nitrates: Long-acting nitrates are also proven to be potent and efficacious. It is often added complimentary to calcium channel blockers.
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Fluvastatin: It can be used as an add-on for tackling vasospastic angina attacks. It brings down the body's fat synthesis, thereby ensuring patent blood flow through the arteries.
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Lifestyle Modifications: Practicing healthy eating habits, keeping track of body weight within the required limit, and staying away from smoking and other drug usage are some lifestyle alteration strategies that can remarkably impact cardiac health.
Conclusion
Vasospastic angina is a less frequently encountered form of angina, where the affected person elicits considerable tolerance to physical activities, and the pain attack is manifested during rest or sleep. It is often underdiagnosed and, at times, misinterpreted as other cardiac conditions. Since the cardiac activity is momentarily altered during the vasospasm, it gets reflected in the electrocardiogram recordings. Promising treatment interventions coupled with lifestyle alterations are proven effective for vasospastic angina. It enhances the quality of life and improves the longevity of the patients.
