"spasm angina why saying angina confuses?..."

Symptoms

These are variable, from brief unnoticed episodes to severe prolonged angina.

This variant of angina occurs at rest, usually lasting for between 5 and 30 minutes. Most episodes occur between midnight and early morning.[3]

Any episode, include brief and otherwise unnoticed episodes, can result in myocardial ischaemia, life-threatening arrhythmias and sudden death.

A few patients have a general abnormality of vasomotor tone. They may also present with symptoms of migraine headache and Raynaud's phenomenon.

Finding other evidence of diffuse atherosclerotic disease does not differentiate patients with variant angina from those with unstable angina. Physical examination does not reliably differentiate between variant angina and occlusive coronary artery disease.

Episodes of coronary artery spasm (particularly in the morning when spontaneous coronary artery spasm is most likely to occur) can be precipitated by:

Physical or mental stress.

​Cold air / cold shock reaction

Magnesium deficiency.

Alcohol consumption.

Hyperventilation.

The Valsalva manoeuvre.

Pharmacological agents such as cocaine.

Sympathomimetic agents - eg, adrenaline (epinephrine), noradrenaline (norepinephrine).

Beta-blockers.

Parasympathomimetic agents - eg, methacholine, pilocarpine.

Ergot alkaloids - eg, ergotamine.

​Eating a large meal (over eating in one sitting)

Differential diagnosis

See also separate Chest Pain and Cardiac-type Chest Pain Presenting in Primary Care articles.

Distinguishing Prinzmetal's angina from an acute coronary syndrome is very difficult and so patients usually require hospital assessment and admission.

Many patients with coronary artery spasm also have obstructive coronary artery disease.

Investigations

FBC, renal function, electrolytes, fasting blood glucose and lipid levels.

Cardiac enzymes and troponins to assess for acute coronary syndrome.[4]

ECG: transient ST-segment elevation corresponding to the distribution of the affected coronary artery during attacks is characteristic.[1]

Ambulatory ECG monitoring may be required because episodes of coronary artery vasospasm are often brief and ECG findings are often normal between attacks.

Coronary angiography is the gold standard for the diagnosis of variant angina. Several provocative tests for coronary spasm are used, including ergonovine, acetylcholine, neuropeptide Y and dopamine.[5]

If coronary revascularisation is not being considered or invasive coronary angiography is not clinically appropriate or acceptable to the person, offer non-invasive functional imaging. Options for non-invasive functional testing include:

Myocardial perfusion scintigraphy (MPS) using single photon emission computed tomography (SPECT).

Stress echocardiography.

First-pass contrast-enhanced magnetic resonance (MR) perfusion.

MR imaging for stress-induced wall motion abnormalities.

?Please also be aware to openly discuss with your GP Doctor Primary Healthcare person Cardiologist - Many don't and or wont use invasive investigation due to other risks to health that the process will possibly bring on. They would like to diagnose from symptoms primarily, so always keep a good log of all your event episodes. While the procedures are considered safe, there is also a small risk. 

Treatment options

Nitrates and calcium-channel blockers are the mainstay of medical therapy:

Glyceryl trinitrate effectively treats episodes of angina and myocardial ischaemia and long-acting nitrate preparations reduce the frequency of recurrent events.

Calcium-channel blockers are very effective in preventing coronary vasospasm and variant angina.

Beta-blockers, especially those with non-selective adrenoceptor blocking effects, may aggravate coronary artery spasm and therefore should be avoided. (raised ST espeacially so)

Implantable cardioverter defibrillator devices have been used in patients who survive ventricular tachycardia or fibrillation due to coronary artery spasm. This treatment is controversial for primary prevention but should be considered for high-risk patients.

Trouble is they are not Specialists,cannot ask why, do not want to liase with any  either, so  further cause anxiety by saying one matter at time when should know that condition reveal themselves  as multi symptoms as in  case of heart failure.  When had MI revived with an angioplasty & Reveal device [ implanted] only revealing PAH not showing up the spasms on tests .Could it be the  operational equipment is not inline with the testing? When you are single, solo & 70yrs it is  a health & safety risk & very worrying as we have now CCGs /LAs making  life & death decisions [ access]  when have not had the education, experience  & specialism  to do that ethically .

I wish I had found this article once I was diagnosed. It's a whole lot deep, however, since I found it, it has been the guide to many Google searches that have opened my eyes. It has the most information in one place (that is understandable) of any I have found. 

It's called

Difficulty in diagnosing Prinzmetal's Angina-In Depth Description

Reprinted from:

European Journal of Cardio-Thoracic Surgery Oxford Journals

Medicine & Health  

European Journal Cardio-Thoracic Surgery

Volume 29,  Issue 5

Pp.  748-759.

Here's the link

[b]http://prinzmetal.org/contents/en-us/d146_Complete_article[b].html

My reply is being moderated, SHOCKING!😛. When it does come through its link to a very interesting article on Prinzmetals.