Now let's look at that really weird one, that
variant angina, or prinzmetal angina.
That's caused by a vasospasm.
And because the vessel is -- spasming,
you have supply ischemia issues.
So the pathophysiology, just to quickly
remind you, remember,
it's a coronary artery spasm.
And that's because
remember those little endothelial cells
that we have around the linings,
they have some kind of weird
dysfunction going on.
Maybe there's damage or smooth
We're not exactly clear on why
this happens in patients,
but we're very clear that it does.
So it happens most often at night,
which that's really creepy, isn't it?
That's because you have a higher
vagal tone at night,
but this is not how you want to
wake up, is it, with chest pain,
but patients often report that's when
they most often feel variant angina.
So, what's our strategy?
Well, since it's a spasm,
our goal is to increase the
cardiac oxygen supply.
Best way to do that in a spasm
is to be to try to relax that spasm, right?
So the drugs we're going to use are
calcium channel blockers.
We can also use organic nitrates and
beta blockers are not our friends.
So I want you to star that
point in your notes.
We don't use beta blockers
for variant angina.
They won't help.
So we use calcium channel blockers
and organic nitrates,
but we do not use beta blockers
with this type of chest pain.