Prinzmetal angin a is-
Correct Answer: Caused due to spasm of artery
Description: Ans. is 'c' i.e., Caused due to spasm of artery o Variant angina (VA) which is also referred to as Prinzmetal angina, is a clinical entity characterized by episodes of anein a pectoris, usually at restand often between midnight and early morning, in association with ST-segment elevation on the electrocardiogram (ECG) Episodes are triggered by coronary artery vasospasm, which generally occurs in the absence of high grade coronary artery stenosis.o Variant angina has characteristics that allow it to be distinguished from stable angina pectoris, unstable angina, or microvascular angina.Pathogenesiso Variant angina (VA) is usually caused by focal spasm (of the smooth muscle layer of the arterial wall) of a major coronary artery, resulting in a high-grade obstruction.o Vascular smooth muscle hyper-reactivity is thought to be central to the pathogenesis of variant angina.o Spasm occurs in the absence of any preceding increase in myocardial oxygen demand (eg, exercise) and innormal or diseased vessels.Clinical presentationo Patients with variant angina typically present with a chronic pattern of recurrent episodes of chest pain,o The quality of the chest pain is indistinguishable from classical angina pectoris associated with obstructive coronary artery disease; however, the context in which it occurs differs.o In particular, patients with variant angina report that their episodes are predominantly at rest and that many occur from midnight to early morning.o Each episode of chest pain generally lasts 5 to 15 minutes.Diagnosiso The diagnosis of variant angina is made when a patient with recurrent episodes of anginal type chest pain, which generally occur at rest, is found to have transient ST-segment elevation on an electrocardiogram at the time ofan episode and subsequently found to not have high grade coronary stenoses at coronar> arteriography.ManagementSmoking cessationo As smoking cessation removes one of the triggers for variant angina and leads to a significant decrease in the frequency of episodes, at least in the short term, smoking cessation should be encouraged.Nitrates and calcium channel blockerso Calcium channel blockers (nifedipine, diltiazem, and verapamil) and nitrates are effective as chronic therapies for variant angina.o Both present vasoconstriction and promote vasodilation in the coronary vasculature.o For patients who do not have acceptable improvement in symptoms on calcium channel blocker therapy, add a long-acting nitrate.Rho kinase inhibitorso Fasudil is a rho kinase inhibitor that has been shown to inhibit acetylcholine-induced spasm.Statinso Statins have been shown to be effective in preventing coronary# spasm and may exert their benefits via endothelial nitric oxide or direct effects on the vascular smooth muscle.
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