In the first few days after a person experiences angina for the first time, it cannot be determined whether a person will have a stable pattern or will quickly develop an unstable one. For this reason, those with a new onset of angina, no matter how mild, are usually treated as though they have unstable angina.
There is another less common form of angina called “variant angina,” “atypical angina” or “Prinzmetal’s angina” (named for one of the doctors who first described it). It is caused by spasm of an area of a coronary artery. The symptoms are similar to those of the other forms of angina, but usually occur at rest and may occur in younger persons and those felt to be at low risk for CAD (though cigarette smoking is quite often associated with this form of angina, too). Nitroglycerine and other medications that relax the blood vessel spasm help relieve the problem. Though it sounds like unstable angina, the risk of heart attack is lower with variant angina because underlying rigid blood vessel blockage is not the problem and the spasm is reversible. Because they seem so similar in terms of symptoms, the definitive diagnosis of atypical angina often requires an angiogram or cardiac catheterization to look for underlying CAD. Sometimes patients with variant angina will also have underlying CAD that may or may not give them a different pattern of symptoms.
How is angina diagnosed and evaluated?
Angina is first suspected based on a person’s symptoms – the more typical the symptoms, the easier it is to diagnose. Patients with neck or arm pain, dizziness, or nausea present more of a challenge for the patient and physician because these symptoms are linked to many other problems besides heart disease. In any case, once angina is suspected, several tests help to evaluate things further – including confirming the diagnosis and determining the severity of the underlying CAD, which will help to determine the optimal treatment. In each case, deciding which test is best depends on the level of suspicion for CAD and angina and the suspected severity of the underlying problem.
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