Variant Angina

Variant Angina - Dubai Cardiology Clinic

Unlike exertional angina, it occurs at rest and especially at night between midnight and early morning hours. It is very painful and looks like heart attack.It appears at 1-2% of all types of angina.

Cause of variant angina

The main cause is a coronary spasm, and more likely above area with plague (non-significant stenosis). It is associated with transient ST elevation in ECG mimic heart attack but it comes back to normal after the relieve of episode. Coronary spasm can result from:

  • Cold weather.
  • Stress.
  • Smoking.
  • Cocaine.
  • Some medicines that tighten or narrow blood vessels like cold medicine.

Which medicine can relieve this episode?

There are two main drugs that helps improve the pain: Nitroglycerin sublingually and Calcium blocker orally like diltiazem.

Is variant Angina serious?

It is very serious. Usually, the coronary spasm is brief but if variant angina is left untreated, it can contribute to arrythmia, heart attack, cardiac arrest, and even death. It responded well to sublingual Nitroglycerin and oral calcium blocker such as diltiazem. The prognosis in general is good in the long term.

Any diagnostic issue?

The ECG helps to show transient ST elevation like heart attack during the episode and provocative testing with ergonovine or acetylcholine outside the episode in the catheter laboratory.


Dubai Cardiology Clinic - Treatment of various cardiovascular diseases such as Hypertension, Ischemic heart disease, Holter monitoring, Heart failure, Stress test, chest pain and echocardiography are now available in DRHC.


Dr. M. Adib Nanaa

Specialist Cardiologist