Mechanism: Prinzemetal agina is due to vasospastic coronary arteries. Think of a patient with Asthma. they have hyperactive bronchial smooth muscles...so you contraindicate beta-blockers as that would exacerbate the situation. Well same thing here. You have hyperactive vasopastic coronary arteries, so anything that increases cathecholamines (cocaine) would exacerbate Prinzemetal's Angina.
Cocaine inhibits NE reuptake so it acts on sympathetic system. It causes vasospasm -> Variant angina.
Cocaine does not act directly on the atheromatous plaque.
Thank you guys !
I had the same understanding .. the thing is Goljan mentions 'cocaine abuse' in his book as one of the causes of Stable angina , so I was like !!
This is true because cocaine causes hypertension and thus the chronic exposure can, indirectly, promotes the development of a plaque.
However, always consider the age of the patient. A young patient wt an acute exposure it is plausible to be a variant angine. Otherwise if it is a middle age pt wt a note cv risk factors history, it could be an organic angina.
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