A 52-year-old man presents with recurrent episodes of rest angina occurring between midnight and early morning. During one episode, ECG shows transient ST elevation in leads II, III, and aVF that resolves spontaneously within minutes. Troponin is normal. Coronary angiography reveals no significant fixed stenosis. Which is the most appropriate long-term therapy?

• A Aspirin and clopidogrel
• B Long-acting nitrates alone
• C Calcium channel blockers ✓
• D Coronary artery bypass grafting

Explanation

This is variant (Prinzmetal) angina caused by coronary artery spasm, typically in young smokers with normal coronaries on angiography. Calcium channel blockers are first-line therapy to prevent spasm. Long-acting nitrates can be added but are not sufficient alone. Antiplatelet therapy has no role since there is no fixed atherosclerotic lesion. CABG is not indicated in the absence of significant stenosis.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.