Which finding is most characteristic of Prinzmetal (variant) angina?

Which finding is most characteristic of Prinzmetal (variant) angina?

• A. Troponin elevation during episode
• B. Chest pain at rest with normal troponin
• C. ST-segment elevation during episodes that resolves with nitroglycerin and occurs at rest
• D. Exertional chest pain with troponin elevation

Answer: (C)

Prinzmetal angina is defined by coronary vasospasm causing transient ischemia, most characteristically producing ST-segment elevation on the ECG during chest pain that then resolves as the spasm eases, often with nitroglycerin. This pattern—ST elevation during episodes at rest that is relieved by nitrates—is what makes this finding distinctive. Troponin is typically not elevated unless a spasm lasts long enough to cause myocardial injury, so the absence of troponin rise during an episode further supports a vasospastic process rather than an acute infarction. In contrast, chest pain at rest with normal troponin but without ST changes, or exertional chest pain with troponin elevation, fits other forms of angina or myocardial infarction rather than classic Prinzmetal angina.

Prinzmetal angina is defined by coronary vasospasm causing transient ischemia, most characteristically producing ST-segment elevation on the ECG during chest pain that then resolves as the spasm eases, often with nitroglycerin. This pattern—ST elevation during episodes at rest that is relieved by nitrates—is what makes this finding distinctive. Troponin is typically not elevated unless a spasm lasts long enough to cause myocardial injury, so the absence of troponin rise during an episode further supports a vasospastic process rather than an acute infarction. In contrast, chest pain at rest with normal troponin but without ST changes, or exertional chest pain with troponin elevation, fits other forms of angina or myocardial infarction rather than classic Prinzmetal angina.