Do you also have chest pain at night while resting? It could be Prinzmetal Angina!

Imagine that you have worked hard all day, finished all your work, and just went to bed at night... Or, on a holiday, while you are watching TV, you suddenly feel a sharp pain in the middle of your chest, as if someone is squeezing you. The strange thing is, you have not been tired at all, you have not run around, you are not under any pressure. This pain comes when you are relaxed and at ease. Many people think that this is gastritis or acid reflux at times like these. But this is something completely different, you need to be a little careful, it could be a rare condition related to heart disease. That is what we are going to talk about today.

What exactly is Prinzmetal Angina?

Simply put, Prinzmetal Angina is a rare type of chest pain (angina condition) . The specialty of this is that this pain occurs when you are at rest, especially between midnight and the morning. It is also called variant angina, angina inversa, and vasospastic angina.

Now you may be wondering, "What is angina?" Angina is chest pain that occurs when our heart muscles do not get enough oxygenated blood. Just like a water pump makes a noise when it runs out of water, the heart signals when it is not getting enough blood. This is usually caused by cholesterol deposits in the coronary arteries that supply blood to the heart, narrowing them.

But in Prinzmetal Angina, something a little different happens. Here, the arteries may be narrowed or even blocked. The main cause of this is that the coronary arteries in the heart suddenly and for no reason contract (spasm) or spasm. Imagine it as if someone suddenly squeezed a water pipe. Then the blood supply is temporarily completely cut off. That's when that severe chest pain comes. After a while, when this spasm disappears on its own, the pain also decreases.

What is the difference between normal angina and Prinzmetal angina?

Although both of these conditions are chest pains, there are clear differences between the two. Let's look at this table to make it easier to understand.

Who is affected the most by this situation?

Prinzmetal Angina is a very rare condition. According to the American Heart Association, only two out of 100 angina patients have this condition.

It can affect both men and women. It is especially common in people who have other conditions that cause blood vessel blockage. For example:

• Migraine headaches: Headaches caused by constriction of blood vessels in the head.
• Raynaud's phenomenon: A condition in which the blood vessels in the fingers and toes constrict, causing them to turn pale and bluish when exposed to cold.

Having both of these conditions means that the blood vessels in your body are more sensitive and more easily constricted than normal. So the blood vessels in your heart are likely to behave in the same way.

It can also develop in people with high cholesterol or high blood pressure. But the surprising thing is that even a healthy, young person with no risk factors can develop Prinzmetal Angina .

It is not known for sure whether this is a hereditary disease. However, some studies suggest that there may be a genetic link. For example, the disease is more common among Japanese people than among white people.

What are the symptoms of Prinzmetal Angina?

If you have Prinzmetal Angina, you may experience the following symptoms:

• Severe chest pain: A squeezing, squeezing, or pressure-like pain in the center of the chest. This pain may radiate to the left arm, shoulder, neck, or head.
• Pain pattern: This pain is not constant. It is intense for about 5-15 minutes and then subsides on its own. However, it can recur at the same time, in the same way, for several days or weeks. This means that these episodes of pain occur according to a certain pattern.
• Other symptoms: Chest pain may be accompanied by sweating, nausea, and/or fainting .
• Relief with medication: The pain is usually relieved quickly by taking nitrate-type medications (tablets placed under the tongue) that are usually prescribed for this pain.

Why does Prinzmetal Angina occur? What are the main causes?

As we have already mentioned, the primary cause of Prinzmetal Angina is a sudden narrowing (spasm) of the coronary arteries of the heart. But the question is, "Why do these arteries narrow involuntarily?" Several main triggers have been identified that affect this.

• Tobacco use: Smoking is the main and most serious trigger for this condition. The nicotine and other chemicals in tobacco cause the blood vessels to constrict severely.
• Drug use: Drug use, such as cocaine and marijuana, can significantly constrict blood vessels.
• Certain medications: Some medications have the property of constricting blood vessels. For example, some migraine medications (e.g. sumatriptan) or ephedrine, which is found in some cold and nasal decongestant medications.
• Severe stress: Emotional stress can alter the body's hormonal function and cause blood vessels to constrict.
• Exposure to cold: Exposure to extremely cold environments can also cause this condition in some people.
• Exercise: Surprisingly, some people can experience this condition not only when they are resting, but also when they are exercising. However, this is very rare.

How is this diagnosed?

Prinzmetal Angina is a bit challenging to diagnose because, if you have an ECG or angiogram when you are not in pain, everything will often look normal because the arteries are not blocked at that time.

So your doctor will listen carefully to your symptoms. Things like when the pain occurs, the pattern of the pain, what you do, etc. Then, they may do some tests to confirm the diagnosis.

• Ambulatory Electrocardiogram: This is like a small EKG machine that is attached to your body for 24 or 48 hours. It continuously records your heart's activity while you go about your daily activities. This can help you see if your heart's EKG changes when you have chest pain at night.
• Coronary Angiography: This involves injecting a special dye into your coronary arteries and examining the condition of those arteries using X-rays. This can accurately determine whether the arteries are narrowed due to cholesterol deposits.
• Provocation Test: Sometimes, once the diagnosis is confirmed, doctors have to artificially induce the narrowing of the artery in the hospital, under close observation. For this, drugs such as acetylcholine or ergonovine are given in small doses. If the artery narrows, the changes in the EKG and your symptoms can be used to accurately diagnose the disease.

Treatment methods and management

Once this condition is recognized, there is no need to panic. It can be very well controlled with medication and lifestyle changes.

Treatment with medication

• Calcium Channel Blockers: This is the main type of medication used for Prinzmetal Angina. These medications work by relaxing the walls of the blood vessels and preventing them from constricting. Diltiazem, Amlodipine, Verapamil are examples of this type of medication.
• Nitrates: These are long-acting medications given daily. They can also be taken as short-acting sublingual tablets, which are placed under the tongue for quick relief in case of sudden chest pain. These work by rapidly dilating blood vessels and restoring blood flow.

Lifestyle changes

As well as medication, it's also essential to change your lifestyle, especially avoiding the triggers we talked about completely.

• Stop smoking immediately: If you are a smoker, you should stop smoking completely right now. This is the best thing you can do.
• Avoid drugs: Completely avoid using drugs like cocaine and marijuana.
• Avoid trigger medications: Talk to your doctor about other medications you are taking. Some decongestants, weight loss products, and even energy drinks may contain ingredients that can constrict blood vessels.

What kind of hope can we have while living with this situation?

If treated properly, the prognosis for someone with Prinzmetal Angina is very good. You can live a normal life. However, you must receive long-term treatment and clinical follow -up under a cardiologist.

However, if Prinzmetal Angina is accompanied by an irregular heartbeat (arrhythmia), or if there is permanent narrowing of the coronary arteries due to cholesterol deposits (coronary artery disease), the situation can be a bit more complicated.

Prinzmetal Angina is not a life-threatening condition. It is a symptom. But it does indicate that there is a problem with the blood supply to your heart. If left untreated, this narrowing of the arteries can lead to a heart attack (myocardial infarction) or serious arrhythmias. So don't take this condition lightly.

When should you seek medical advice?

This is the most important part.

The doctor will perform the necessary tests and find the exact cause of the pain.

If you experience severe, intense chest pain, difficulty breathing, excessive sweating, or fainting, it may be an emergency. In such cases, go to a hospital's Emergency Treatment Unit (ETU) immediately.

If you are diagnosed with Prinzmetal Angina, follow your doctor's instructions and medications exactly as prescribed. Make the necessary lifestyle changes. Remember, this is a manageable condition. All it takes is your commitment and regular contact with your doctor.