A 45-year-old male smoker reports recurrent chest pain that wakes him at around 3 am and lasts 15 minutes. During an episode, ambulatory monitoring records transient ST elevation that normalises once the pain settles. Coronary angiography between episodes shows angiographically normal epicardial arteries. Which drug class is the mainstay of long-term therapy?

• A Calcium channel blockers ✓
• B Non-selective beta-blockers
• C Ranolazine monotherapy
• D Ivabradine

Explanation

Variant (Prinzmetal) angina results from episodic focal coronary vasospasm, producing transient transmural ischaemia with reversible ST elevation at rest, typically at night or early morning. Calcium channel blockers such as diltiazem or amlodipine, combined with nitrates, are the cornerstone of therapy. Non-selective beta-blockers are contraindicated because unopposed alpha-mediated vasoconstriction can worsen spasm, and revascularisation offers no benefit when arteries are structurally normal.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.