A 42-year-old male smoker reports recurrent episodes of chest pain at rest between midnight and early morning. During an episode, ECG shows transient ST elevation in leads II, III and aVF that resolves completely within minutes with pain relief. Coronary angiography shows no fixed stenosis. Which drug class is first line for preventing these episodes?
- A Beta-adrenergic blockers
- B Nitrates used only during acute episodes
- C Calcium channel blockers ✓
- D Dual antiplatelet therapy with aspirin and ticagrelor
Correct answer: C. Calcium channel blockers
Explanation
The nocturnal rest pain with transient ST elevation and angiographically clean coronaries defines variant (Prinzmetal) angina caused by coronary vasospasm. Calcium channel blockers such as diltiazem or amlodipine are the mainstay of prevention, combined with nitrates and smoking cessation. Non-selective beta blockers can worsen spasm by leaving alpha-mediated vasoconstriction unopposed, so option A is actively harmful here.
Reference: Ganong's Review of Medical Physiology, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.