Vasospastic Angina

Episode overview

Vasospastic angina, also called Prinzmetal angina, is caused by transient coronary artery spasm and classically presents with chest pain at rest, often at night or early in the morning. In this episode, we review the classic presentation of vasospastic angina, why transient ST-segment elevation can occur, how to distinguish it from stable angina and acute coronary syndrome, the role of coronary angiography and acetylcholine provocation testing, first-line treatment with calcium channel blockers, why beta blockers may worsen coronary vasospasm, and important triggers including smoking and stimulant use.