There’s a type of angina that can occur at rest but not during exertion.

Maybe you know that “unstable angina” can occur at rest, even during sleep and awaken the patient.

But this type of angina (caused by plaque buildup in the coronary arteries) will also strike when the patient exercises or induces physical exertion such as carrying a heavy box to the car or running up a flight of stairs.

But can angina occur only during rest and not during physical activity?

“There is a syndrome called Prinzmetal’s angina (also called variant angina or vasospasm),” says Monica Reynolds, MD, a cardiologist with ColumbiaDoctors Medical Group in White Plains, NY.

“It is not very common and often hard to document (requires a cardiac cath using provocative agent to induce spasm),” continues Dr. Reynolds.

“It is caused by vasospasm (contraction and narrowing) of the coronary arteries rather than atherosclerosis (plaque buildup).  It occurs more in younger women.”

This doesn’t mean older women, or men, are immune to this condition.

“The treatment is slightly different than classic angina – nitrates and calcium channel blockers are usually used (as opposed to beta blockers),” says Dr. Reynolds.

Prinzmetal’s angina increases the risk of heart attack and sudden death, so don’t assume that just because there may not be much plaque buildup, doesn’t mean this condition is necessarily benign.

More About Prinzmetal’s Angina

The coronary artery may be as clear as a whistle, but the spasm reduces its diameter to that comparable to what severe coronary artery disease does.

However, this “variant” angina can also affect someone who already has diseased vessels.

Prinzmetal’s cannot be diagnosed with a treadmill stress test. The most sensitive test is an IV administration of ergonovine at specific intervals. If a spasm results, this will show on a concurrent EKG.

When a coronary artery narrows either due to plaque buildup or a vasospasm, the body doesn’t know the difference — in that angina will result, even during rest.

Since 1992 Dr. Reynolds has practiced clinical cardiology at ColumbiaDoctors Medical Group, one of the largest multi-specialty practices in New York State.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer. 


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