Beltrame et al reported criteria for the diagnosis of vasospastic angina (VSA). The authors are from the Coronary Vasomotor Disorders International Study Group (COVADIS)
Synonyms: Prinzmetal angina, variant angina
Criteria:
(1) nitrate-responsive angina during spontaneous episode with one or more of the following:
(1a) rest angina (especially between night and early morning)
(1b) marked diurnal variation in exercise tolerance (reduced in morning)
(1c) episode precipitated by hyperventilation
(1d) calcium channel blockers suppress episodes; beta-blockers do not
(2) ECG shows transient ischemic change with one or more of the following:
(2a) ST segment elevation >= 0.1 mV in at least 2 continguous leads
(2b) ST segment depression >= 0.1 mV in at least 2 contiguous leads
(2c) new negative U wave
(3) coronary artery spasm (transient subtotal or total coronary artery contriction with angina and ischemic ECG changes either spontaneously or in response to provocative testing)
where:
• Subtotal coronary artery occlusion is > 90% constriction.
• Provocative agents include acetylcholine, ergot or hyperventilation.
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Nitrate-Responsive Angina
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Other 2 Criteria
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Diagnosis
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present during spontaneous episodes
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one or both
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definitive
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present during spontaneous episodes
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(ECG unavailable or equivocal) AND (coronary artery spasm equivocal)
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suspected
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absent
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both absent
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absent
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other
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other
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uncertain
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