Which statement best describes Prinzmetal or Variant angina?

Which statement best describes Prinzmetal or Variant angina?

• A. It is the most common form and occurs during heavy exertion.
• B. It occurs in a recurrent pattern primarily during sleep, often between 12am and 8am.
• C. It always accompanies a heart attack.
• D. It occurs only in elderly patients with comorbidities.

Answer: (B)

Prinzmetal angina is caused by intermittent coronary vasospasm that briefly narrows a coronary artery, producing transient chest pain from temporary ischemia. The defining feature is its episodic nature at rest, often following a circadian pattern that peaks during sleep, typically in the late night to early morning hours. During a spasm, the ECG can show transient ST‑segment elevation, which resolves when the vessel relaxes. This pattern is different from exertion‑triggered angina, which arises from fixed atherosclerotic narrowing and demand during activity. Because the problem is vasospasm rather than a fixed blockage, it can occur in people who are not elderly or heavily burdened with other diseases, and it is not inherently linked to a heart attack—myocardial infarction may occur if a spasm is prolonged, but that is not a defining or necessary feature. The other statements don’t fit: exertion‑driven angina is more typical of stable angina due to fixed lesions; Prinzmetal can cause ischemia without a heart attack and does not have to accompany one; and it is not restricted to elderly patients with comorbidities. In short, the hallmark description is recurrent episodes occurring primarily at rest, often during sleep (around midnight to early morning).

Prinzmetal angina is caused by intermittent coronary vasospasm that briefly narrows a coronary artery, producing transient chest pain from temporary ischemia. The defining feature is its episodic nature at rest, often following a circadian pattern that peaks during sleep, typically in the late night to early morning hours. During a spasm, the ECG can show transient ST‑segment elevation, which resolves when the vessel relaxes. This pattern is different from exertion‑triggered angina, which arises from fixed atherosclerotic narrowing and demand during activity.

Because the problem is vasospasm rather than a fixed blockage, it can occur in people who are not elderly or heavily burdened with other diseases, and it is not inherently linked to a heart attack—myocardial infarction may occur if a spasm is prolonged, but that is not a defining or necessary feature.

The other statements don’t fit: exertion‑driven angina is more typical of stable angina due to fixed lesions; Prinzmetal can cause ischemia without a heart attack and does not have to accompany one; and it is not restricted to elderly patients with comorbidities.

In short, the hallmark description is recurrent episodes occurring primarily at rest, often during sleep (around midnight to early morning).