A Comprehensive Literature Review Discussing Diagnostic Challenges of Prinzmetal or Vasospastic Angina
Aswathappa, Shruthi Watson, Aolani J Nawaz, Bushra Jani, Abhishek Razi, Sara Baral, Srijana Chanayire, Gabriel W Hakeem, Rukhsana George, Anju Islam, Rabeeul
Aswathappa, Shruthi
Watson, Aolani J
Nawaz, Bushra
Jani, Abhishek
Razi, Sara
Baral, Srijana
Chanayire, Gabriel W
Hakeem, Rukhsana
George, Anju
Islam, Rabeeul
Affiliation
Medical College Bengalura; Anhui Medical University Hefei; The Duldey Group NHS Foundation Trust
Other Contributors
Publication date
2025/06/09
Subject
Collections
Research Projects
Organizational Units
Journal Issue
Abstract
This narrative review addresses the diagnostic complexities of vasospastic angina (VSA), also known as Prinzmetal angina, by analyzing findings from peer-reviewed studies published over the past decade. It highlights clinical characteristics, guideline-directed approaches, and diagnostic strategies for VSA and ischemia with non-obstructive coronary arteries (INOCA). Although intracoronary provocation testing with acetylcholine or ergonovine remains the gold standard, its use is limited due to procedural variability and restricted access. Non-invasive modalities such as positron emission tomography (PET) imaging, cardiac magnetic resonance imaging (MRI), optical coherence tomography (OCT), and ambulatory electrocardiogram (ECG) monitoring have demonstrated promise but often lack consistency in diagnostic yield. Recent advances, including artificial intelligence (AI)-based ECG interpretation, inflammatory biomarkers, and microRNA profiling, are emerging as tools to improve diagnostic precision and risk stratification. VSA often remains underdiagnosed due to its transient symptoms, resemblance to acute coronary syndromes, and influence of patient factors like age, sex, comorbidities, and symptom variability. Enhancing diagnosis requires standardized testing protocols, broader use of coronary function testing, and integration of novel imaging and biomarker technologies. Recognizing atypical presentations, particularly in younger patients and women, is crucial to reducing misdiagnoses and improving clinical outcomes.Z S Ahmed, S Azam, A Shenton, A A Akingboye, 988 De Garengeot�s Hernia: Acute Appendicitis Within a Femoral Hernia � Diagnostic Challenges and Management, BJS, Volume 112, Issue Supplement_10, June 2025, znaf128.148, https://doi.org/10.1093/bjs/znaf128.148
Citation
Aswathappa S, Watson AJ, Nawaz B, Jani A, Razi S, Baral S, Chanayire GW, Hakeem R, George A, Islam R, Fahima C, Ali R. A Comprehensive Literature Review Discussing Diagnostic Challenges of Prinzmetal or Vasospastic Angina. Cureus. 2025 May 8;17(5):e83745. doi: 10.7759/cureus.83745