Which statement about variant (Prinzmetal) angina is true?

Which statement about variant (Prinzmetal) angina is true?

• A. It is primarily triggered by physical exertion
• B. It is caused by coronary vasospasm, often at rest
• C. It requires surgical intervention
• D. It is unrelated to ST-segment changes

Answer: (B)

Princetalangina is driven by a transient spasm of a coronary artery that cuts off blood flow just enough to cause brief, reversible ischemia. This vasospasm often happens when the person is at rest, including at night, and can be triggered by factors like smoking or certain drugs. The key feature is the sudden onset of chest pain with transient ST-segment elevations on the ECG during the episode, which then resolves as the spasm subsides or with nitroglycerin or calcium channel blockers. This is why the statement describing coronary vasospasm occurring often at rest is the best choice: it captures the main mechanism and the typical clinical pattern of Prinzmetal angina, plus the associated ST-segment changes. It’s not mainly triggered by physical exertion (that pattern describes classic effort-induced angina from fixed atherosclerotic narrowing), and it does not ordinarily require surgical intervention—medical therapy with calcium channel blockers and nitrates, along with addressing triggers, is the standard approach. The condition is not unrelated to ST changes; the episodes characteristically show transient ST elevations during pain.

Princetalangina is driven by a transient spasm of a coronary artery that cuts off blood flow just enough to cause brief, reversible ischemia. This vasospasm often happens when the person is at rest, including at night, and can be triggered by factors like smoking or certain drugs. The key feature is the sudden onset of chest pain with transient ST-segment elevations on the ECG during the episode, which then resolves as the spasm subsides or with nitroglycerin or calcium channel blockers.

This is why the statement describing coronary vasospasm occurring often at rest is the best choice: it captures the main mechanism and the typical clinical pattern of Prinzmetal angina, plus the associated ST-segment changes. It’s not mainly triggered by physical exertion (that pattern describes classic effort-induced angina from fixed atherosclerotic narrowing), and it does not ordinarily require surgical intervention—medical therapy with calcium channel blockers and nitrates, along with addressing triggers, is the standard approach. The condition is not unrelated to ST changes; the episodes characteristically show transient ST elevations during pain.