By SUSAN CALLAHAN, Associate Editor and Featured Columnist
If you are having chest pains even when you are at rest, you may be having a heart attack. Or you could be experiencing a rare form of angina called “Prinzmetal’s angina”.
Prinzmetal’s angina, also called “angina inversa” or “variant angina” are caused by vasospasms, rather than the usual cause of angina --- fat blocking and narrowing your arteries by fatty deposits that is usually the cause of angina.
Prinzmetal’s angina is not very common, affecting only about 2% of people in the U.S. who have angina, according to the American Heart Association. Interestingly, Prinzmetal’s angina is far more common among angina sufferers in Japan, accounting for 40% of Japanese who have angina, according to the 2008 Guidelines for Diagnosis and Treatment of Patients with Vasospastic Angina by the Japanese Circulation Group.
What Causes Prinzmetal’s Angina?
Prinzmetal’s angina is named after its discover, Dr. Myron Prinzmetal, a cardiologist who first described the condition in 1959. The exact cause or causes of Prinzmetal’s are not yet known but scientists have clues. May believe that genetic factors are at play. Specifically, they believe that defects in two genes (eNOS T-786c and stromeolysin-1 5A/6A) reduce the amount of nitrous oxide in the smooth lining of the arteries called the endothelium. Nitrous oxide is necessary for your arteries to relax so the inhibition of nitrous oxide by these genes prevents normal artery relaxation.
Prinzmetal’s angina has a distinct circadian rhythm. One 1999 study led by Dr. H. Yasue of Kumamoto University Medical School, in Japan demonstrated that it is possible to trigger an episode of Prinzmetal’s angina between the hours of 5:00 am and 8:00am in the morning but rarely in the early afternoon.
In addition to having the right or “wrong” genes, certain other conditions can bring on an episode of Prinzmetal’s. These include
-drugs such as cocaine
-sinus arrest, according to one 1994 report from Clinique médicale cardiologique, CHU Dupuytren, in Limoges, France
These last 3 causes --- histamine, acetyl choline and serotonin --- usually cause vasodilation, an expansion of your arteries. However, if your endothelium is already dysfunctional, these 3 chemicals can actually can the reverse --a constriction of your arteries (vasoconstriction), according to a 2011 review from Università Cattolica del Sacro Cuore, Rome, Italy.
Symptoms of Prinzmetal’s Angina
The symptoms of Prinzmetal’s can include
-severe chest pain while resting, at night or in the early morning
- passing out (losing consciousness)
-urinary incontinence in some cases, according to a 2012 study from St Thomas’ Hospital, London. Because of this symptom, Prinzmetal is sometimes confused with epilepsy.
7 Remedies That Help Prinzmetal’s Angina
Prinzmetal’s angina is a serious condition requiring the attention of your doctor. Common treatments include nitrates and calcium channel blockers.
The European Society for Cardiology also notes that the potassium channel opener, nicorandil, and the rho kinase inhibitor, fasudil, have proven effective in treating this condition.
Avoid Smoking. Smoking can cause vasoconstriction and encourages the build-up of plaque which can complicate Prinzmetal’s angina.
Manage Stress. Stress causes constriction of your arteries and can cause severe vasoconstriction, according to a 1995 study Robert Wood Johnson Medical School.
As the study noted, potent mental stress, triggers an increase in heart rate and blood pressure, and “vasoconstriction of normal coronary artery segments in patients with and without angiographically demonstrable coronary artery disease”.
Avoid Hyperventilating. Getting seriously out of breath can trigger an episode of Prinzmetal's angina, according to the European Society of Cardiology.
Eat to Support Artery Health. Avoid meals high in saturated fat, as these can trigger spasms that last several hours. Prefer to use unsaturated fat in your cooking (olive oil, canola oil), prefer fish over red meat and avoid excessive consumption of refined carbohydrates. You should also strive to emphasize fresh fruits especially those rich in Vitamin C) and dark green leafy vegetables. Here is a complete list of foods that help prevent artery spasms.
Avoid Severe Cold. Cold weather challenges your cardiovascular system in general. This is one of the reasons why heart attacks are more common in winter.
Exposure to cold can trigger constriction of your arteries, even if you do not have Prinzmetal’s. If you do have this condition, you should avoid getting much colder than 15 to 20 degrees Celsius (50 to 60 degrees Fahrenheit).
Know Your Danger Time Zones. Prinzmetal’s angina and several other heart conditions have a circadian rhythm, according to a 2015 study from The University of Texas at Austin led by Dr. M.H. Smolensky.
In addition to Prinzmetal’s, many conditions seem to follow a circadian “24 hour” pattern including acute cardiogenic pulmonary edema, heart failure; hypertension, acute orthostatic postprandial, micturition, and defecation hypotension/syncope, intermittent claudication, venous insufficiency, standing occupation leg edema, arterial and venous branch occlusion of the eye, menopausal hot flash, sickle cell syndrome, abdominal, aortic, and thoracic dissections, pulmonary thromboembolism, deep venous thrombosis, cerebrovascular transient ischemic attack and stroke (both hemorrhagic and ischemic).
Consider Yoga and Relaxation Therapy. Yoga, mindfulness, meditation and other relaxation therapies are not only good at lowering stress. They also reduce hyperactivity of your circulatory system,
Even a single session of yoga can improve cardiovascular parameters, according to a 2015 study from Mahatma Gandhi Medical College and Research Institute, Pillayarkuppam, Puducherry, India.