The variant angina is angina that occurs secondary to spasm of epicardial coronary arteries. Symptoms include angina at rest and with exertion rare. Diagnosis is made by ECG and provocative testing with ergonovine or acetylcholine. Treatment includes calcium channel blockers and sublingual nitroglycerin.
(See also Overview for coronary heart disease)
The variant angina is angina that occurs secondary to spasm of epicardial coronary arteries. Symptoms include angina at rest and with exertion rare. Diagnosis is made by ECG and provocative testing with ergonovine or acetylcholine. Treatment includes calcium channel blockers and sublingual nitroglycerin. (See also Overview for coronary heart disease) Most patients with variant angina have a significant fixed proximal obstruction in at least one major coronary artery. The spasms usually occur to 1 cm from the constriction removed (often in combination with ventricular arrhythmias). Symptoms and signs The symptoms are angina pectoris, mostly alone, often at night, and only rarely and irregularly during exercise (unless at the same time a significant obstruction of the coronary vessels is present). The attacks often occur regularly at certain times of day. Diagnosis Provocative tests with ergonovine or acetylcholine during angiography The suspected variant angina is given when an ST segment elevation appears during the seizure. Between the anginal attacks the ECG may be normal or have stable deviating pattern. The diagnosis is confirmed when a coronary spasm is triggered at a challenge test with ergonovine or acetylcholine. A coronary artery spasm is identified by significant ST-segment elevation or by observation of a reversible spasm during cardiac catheterization. The tests are usually performed in a cardiac catheterization laboratory, sometimes on a coronary care unit. Therapy calcium antagonists Sublingual nitroglycerin The average 5-year survival rate is between 89-97%, but the risk of death for patients with a combination of a variant angina and an arteriosclerotic Koronarobstruktion is higher. Normally relieving sublingual nitroglycerin a variant angina quickly. Calcium channel blockers can effectively prevent symptoms. In theory, beta blockers may increase the spasm, because they allow an unhindered alpha-adrenergic vasoconstriction. This effect is not clinically proven. The oral medications most commonly used are calcium channel blockers: diltiazem sustained release 120 to 540 mg sustained-release verapamil (must dose reduced in patients with renal or hepatic impairment) 120-480 mg once / day 1 times daily Amlodipine 15 to 20 mg once / day (dose should be reduced with liver dysfunction in elderly patients and in patients) in refractory cases amiodarone may be effective. However, although the drugs mentioned relieve symptoms, they seem to have no influence on the prognosis.