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Cardiac Pharmacology Questions and Answers (Q&A)

Unlike typical angina – which is often triggered by exertion or emotional stress - Prinzmetal’s angina almost always occurs when a person is at rest, usually between midnight and early morning. These attacks can be very painful. This doesn't sound like our patient, which is likely unstable angina, which does occur at rest.

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The response is the most common intervention to tell the patient. Nitro may cause headaches, however the question asks what is NOT relevant to tell the patient.

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It could be variant or unstable angina. Unstable Angina is Angina that occurs at rest. This is attributed to blocking of 90% of the lumen. The same can happen with Variant, where the patient has a vasospasm which occludes the coronary artery lumen leading to ischemia.

The only way to really differentiate the two would be by first looking at the EKG and second would be through patient history. In unstable Angina, you would have an ST depression because you have ischemia starting at the subendocardial region and moving inwards, meanwhile variant or Prinzmetal angina would have an ST elevation, similar to a STEMI because you have transmural ischemia.

Additionally, unstable angina tends to happen in older individuals as athlerosclerosis develops throughout a patient's life. Prinzmental tends to happen at a younger age and can be related to things like cocaine use, tryptans and tobacco usage.

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