Vasospastic angina

What is vasospastic angina?

Vasospastic angina happens when a coronary artery supplying blood and oxygen to your heart goes into spasm and suddenly narrows. It's also known as Prinzmetal angina, variant angina or coronary artery spasm. 

People experiencing vasospastic angina do not typically have episodes of angina during exercise. If you have coronary artery disease (a build-up of fatty deposits called atherosclerosis in the coronary arteries), this can make the condition worse.

Vasospastic angina can also occur alongside microvascular angina, a condition that affects the tiny arteries within the heart muscle that play a key role in regulating blood supply to the heart.

Vasospastic angina is an under-diagnosed condition that can affect people at any age but is most commonly diagnosed in middle age.  

What are the symptoms of vasospastic angina?

Some people feel the pain or discomfort in their chest, arm or jaw. The pain:

• usually occurs while at rest and in the early morning or late at night
• can be severe or mild (a sense of unease)
• can occur in other locations in the body; the back, shoulders, neck and stomach
• can be eased through taking medication
• can make some people experience sickness.

The spasm can come in ‘clusters’ of two or three. If the spasm doesn't stop it can lead to an abnormal heart rhythm, for which you may need treatment, or in rare instances, a heart attack.

What are the causes of vasospastic angina?

We don’t yet know what causes vasospastic angina, but we do know that the following are often triggers:

• emotional stress
• being in extremely cold weather or a sudden drop in temperature
• hyperventilation (breathing very quickly)
• allergic reactions (usually severe reactions that result in histamine release, sometimes referred to as Kounis Syndrome)
• inflammation of the coronary artery wall
• smoking
• some antidepressants
• some anti-migraine medications 
• using recreational drugs like cocaine and cannabis
• drinking lots of alcohol or binge drinking. 

These triggers may also make the symptoms of vasospastic angina worse and increase the number of angina attacks you have. You can also check with your specialist if any other medications or supplements you take could impact your condition.

How is vasospastic angina diagnosed and treated?

You may need a number of tests to diagnose vasospastic angina, including:

• an ECG (ideally taken at the time of chest pain)
• Coronary angiogram - an x-ray image of your heart’s arteries done while injecting a chemical called acetylcholine which should normally cause your blood vessels to relax. If they don’t relax, your doctor may be able to diagnose you with a coronary artery spasm.

Vasospastic angina is a chronic (long-term) condition that will need to be monitored by your cardiologist, specialist nurse or GP. It can also cause acute (intense) episodes meaning you might need to be admitted to hospital for treatment.

The treatment for vasospastic angina is with:

• Sublingual glyceryl trinitrates (GTN) tablets or spray, which in most cases relieves symptoms quickly
• You may also be given a calcium channel blocker, such as Verapamil, Amlodipine or Diltiazem, to help prevent or reduce the number of spasms you have.

All of these medications relax the coronary arteries to allow more blood to flow through. You should check with your specialist which medications are suitable for you (including when and how often they should be taken).

How do I manage vasospastic angina?

It’s important to recognise any triggers that may be affecting your symptoms and to keep a diary of these so you can let your doctor know.

You mainly manage vasospastic angina with medication, which is very effective in most cases. As with all heart and circulatory conditions, there are many ways you can improve your overall health and reduce your risk of a heart attack, like by:

• maintaining a healthy weight and diet – this will help your overall health and prevent extra strain on your heart.
• keeping active – which has been proven to boost energy, sleep and quality of life.
• managing stress and anxiety
• stopping smoking and using other tobacco products
• limiting how much alcohol you drink (less than the recommended 14 units per week)
• controlling high blood pressure, cholesterol levels and blood sugar levels (if you have diabetes).

What is the outlook for someone living with vasospastic angina?

For some people, vasospastic angina appears and then goes away after some years. For other people, it stays for many years.

When living with vasospastic angina, it's important to find the right exercise and support for you. Your specialist can help you with this.

You may need a referral from your specialist or GP to your local Pain Management Service for chronic pain management and further advice about specific techniques or equipment (e.g. TENS machine) to help with your symptoms.

Living with vasospastic angina can, for some, also lead to anxiety, depression and in some cases post traumatic stress disorder (PTSD), and you may need referral for psychological support from your specialist or GP.

Being diagnosed with vasospastic angina can be frightening and it can take time to come to terms with what's happened. It’s natural to be worried about your recovery, feel scared, frustrated and isolated. For support and advice, visit our emotional support page. 

Heart Helpline & other support:

• Speak to our cardiac nurses by phone, callback, email or online chat on Heart Helpline (Monday to Friday, 9am to 5pm).
• Contact us to talk to our customer care advisors, find your local BHF shop and for any comments, compliments and complaints you may have.
• Sign up to our Heart Matters magazine for online information packed with health and lifestyle advice.
• Find out more about the support you can get through our Heart support groups.
• There is a Facebook group for people with coronary artery spasm or you can connect with others in the BHF HealthUnlocked community.

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Page last updated: March 2023

Next update due: March 2026