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ClearRounds Health · Cardiology · Quick Reference
Coronary Vasospasm / Prinzmetal Angina
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Ischemic Heart DiseaseAdvancedIn progressOne-page PDF
Clinical clues, ECG pattern, triggers, calcium channel blockers/nitrates, beta-blocker cautions, and cath considerations.
Last reviewed
June 12, 2026
Sources / guidelines to verify
- 2023 AHA/ACC Chronic Coronary Disease Guideline (vasospastic/INOCA)
- COVADIS diagnostic criteria
Disclaimer: Educational reference only. Not a substitute for clinician judgment, local protocols, or current guideline review.
One-page reference
Clinically reviewed by the site owner. Still verify against the sources above and local protocol before clinical use.
1
What it is / why it matters
- Transient coronary spasm causing ischemia/angina (Prinzmetal/variant angina).
- Can cause MI, arrhythmia, or arrest — often with non-obstructive coronaries.
2
Key diagnostic clues
- Rest angina, often nocturnal or early-morning and cyclical.
- Transient ST elevation during pain that resolves.
- Triggers: smoking, cocaine/stimulants, hyperventilation, cold.
3
Initial workup
- ECG during pain (transient ST changes), troponin.
- Angiography often non-obstructive; provocative (acetylcholine) testing in specialized settings.
4
Management framework
- Calcium channel blockers are the mainstay ± long-acting nitrates.
- Smoking cessation; stop triggers (especially cocaine).
- AVOID non-selective beta-blockers (can worsen spasm) and triptans/ergots.
5
Red flags / escalate now
- Spasm-induced MI, syncope, or ventricular arrhythmia → admit/cardiology.
6
Follow-up / monitoring
- Symptom control on CCB; trigger avoidance.
7
Clinic pearls
- Rest angina + transient ST elevation + clean coronaries → think vasospasm.
- Use CCBs, not beta-blockers; ask about cocaine.
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