Prinzmetal angina

Prinzmetal angina (variant angina, coronary vessel spasm) is a medical condition characterized by cyclic cardiac chest pain that occurs at rest, it is common in people with abnormal arterial endothelium (endothelial lining of the coronary arteries), endothelium-dependent vasodilatory responses to acetylcholine (ACh) and NO (nitric oxide) does not occur properly in the defected arteries, which may cause constriction of coronary arteries. The pain from Prinzmetal angina is caused by coronary artery vasospasm, which supply blood to the cardiac muscle cells.

Explanation

Normally, Acetylcholine is released by parasympathetic nerves, it acts as a vasoconstrictor and vasodilator in coronary vessels, where it acts on the endothelial cells to release NO, which in turn produces a potent vasodilation of coronary arteries.

Acetylcholine induces vasoconstriction of vascular smooth muscles by direct mechanism. It stimulates endothelial cells to produce nitric acid NO that diffuses out of the endothelial cells stimulating relaxation of the nearby smooth muscle cells thus in healthy arterial walls, indirect vasodilation by acetylcholine mediated by nitric oxide NO is bigger than the direct vasoconstriction effect.

When endothelium is dysfunctional acetylcholine causes vasoconstriction, which is termed prinzmetal’s angina.

Treatment

Nitrates and calcium channel blockers such as Diltiazem, Nifedipine, Amlodipine, Verapamil, etc. are commonly used to help relieve symptoms of prinzmetal angina.

 

 

Verified by: Dr.Diab (July 11, 2017)

Citation: Dr.Diab. (July 11, 2017). Prinzmetal angina Explanation and Treatment. Medcoi Journal of Medicine, 9(2). urn:medcoi:article3282.