National Center for Advancing and Translational Sciences Genetic and Rare Diseases Information Center, a program of the National Center for Advancing and Translational Sciences

Prinzmetal's variant angina


Other Names:
Prinzmetal angina; Variant angina; Angina inversa; Prinzmetal angina; Variant angina; Angina inversa; Vasospastic angina; Coronary artery vasospasm See More
Prinzmetal's variant angina (PVA) is characterized by recurrent episodes of chest pain (angina) that usually occur when a person is at rest, between midnight and early morning. "Typical" angina, by contrast, is often triggered by physical exertion or emotional stress. Episodes of PVA can be very painful, and may last from several minutes to thirty minutes.[1][2][3] In some cases the pain may spread from the chest to the head, shoulder, or arm.[3] The pain associated with PVA is caused by a spasm in the arteries that supply blood to the heart muscle (coronary arteries). This results in an obstruction of blood flow.[1][2] In some people, persistent spasms increase the risk for serious complications such as a life-threatening arrhythmia or heart attack.[2]

PVA most commonly occurs in people who smoke and people who have high cholesterol or high blood pressure.[3] In many cases it occurs for unknown reasons in otherwise healthy people. In some cases it may be triggered by alcohol withdrawal, stress, exposure to cold, certain medications, or use of stimulants such as cocaine.[1][3]

The diagnosis of PVA involves findings on an electrocardiogram, evidence of the spasms on angiogram, and relief of sudden symptoms with medicines called nitrates.[2]

Treatment during an episode to relieve pain and shorten its duration involves sublingual nitroglycerin (a nitrate).[2][3] Treatment to reduce the frequency of episodes and possibly reduce the risk of serious complications involves calcium channel blockers or long-acting nitrates.[2] For people with PVA who smoke, quitting smoking can lead to a significant decrease in the frequency of episodes.[2] While most people with PVA do not experience serious complications, it is a chronic condition that needs to be monitored over time.[1]
Last updated: 1/8/2018
The main symptom of Prinzmetal's variant angina is recurring episodes of chest pain (angina) that usually occur when a person is at rest, during bedtime hours (around midnight to 8am). Some people report feeling "discomfort" rather than "pain." In some people, pain may spread to the neck, jaw, shoulder, or arm. Other sensations during episodes may include tightness or pressure in the chest, "heart burn," nausea, sweating, dizziness, and palpitations. Episodes tend to last around 5 to 15 minutes (longer in some cases), and tend to be similar to each other.
Last updated: 1/8/2018

Research helps us better understand diseases and can lead to advances in diagnosis and treatment. This section provides resources to help you learn about medical research and ways to get involved.

Clinical Research Resources

  • ClinicalTrials.gov lists trials that are related to Prinzmetal's variant angina. Click on the link to go to ClinicalTrials.gov to read descriptions of these studies.

    Please note: Studies listed on the ClinicalTrials.gov website are listed for informational purposes only; being listed does not reflect an endorsement by GARD or the NIH. We strongly recommend that you talk with a trusted healthcare provider before choosing to participate in any clinical study.

Support and advocacy groups can help you connect with other patients and families, and they can provide valuable services. Many develop patient-centered information and are the driving force behind research for better treatments and possible cures. They can direct you to research, resources, and services. Many organizations also have experts who serve as medical advisors or provide lists of doctors/clinics. Visit the group’s website or contact them to learn about the services they offer. Inclusion on this list is not an endorsement by GARD.

Organizations Supporting this Disease

These resources provide more information about this condition or associated symptoms. The in-depth resources contain medical and scientific language that may be hard to understand. You may want to review these resources with a medical professional.

Where to Start

  • The American Heart Association has an information page on Prinzmetal's variant angina. The American Heart Association is the nation’s oldest and largest voluntary organization dedicated to fighting heart disease and stroke.
  • MedlinePlus was designed by the National Library of Medicine to help you research your health questions, and it provides more information about this topic.
  • The National Heart, Lung, and Blood Institute (NHLBI) has information on this topic. NHLBI is part of the National Institutes of Health and supports research, training, and education for the prevention and treatment of heart, lung, and blood diseases.

In-Depth Information

  • Medscape Reference provides information on this topic. You may need to register to view the medical textbook, but registration is free.
  • The Monarch Initiative brings together data about this condition from humans and other species to help physicians and biomedical researchers. Monarch’s tools are designed to make it easier to compare the signs and symptoms (phenotypes) of different diseases and discover common features. This initiative is a collaboration between several academic institutions across the world and is funded by the National Institutes of Health. Visit the website to explore the biology of this condition.
  • PubMed is a searchable database of medical literature and lists journal articles that discuss Prinzmetal's variant angina. Click on the link to view a sample search on this topic.

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  1. Prinzmetal's or Prinzmetal Angina, Variant Angina and Angina Inversa. American Heart Association. July, 2015; http://www.heart.org/HEARTORG/Conditions/HeartAttack/DiagnosingaHeartAttack/Prinzmetals-or-Prinzmetal-Angina-Variant-Angina-and-Angina-Inversa_UCM_435674_Article.jsp#.Wk-54lWnFD8.
  2. Pinto DS, Beltrame JF, Crea F. Vasospastic angina. UpToDate. Waltham, MA: UpToDate; February 6, 2017; https://www.uptodate.com/contents/vasospastic-angina.
  3. Chen MA. Coronary artery spasm. MedlinePlus. February 24, 2016; http://www.nlm.nih.gov/medlineplus/ency/article/000159.htm.