A 45-year-old woman who smokes heavily reports episodes of rest angina occurring at night. During an episode, transient ST elevation is recorded that resolves with pain relief. Coronary angiography shows angiographically normal epicardial arteries with no fixed stenosis. Which drug class forms the cornerstone of long-term therapy?
- A Non-selective beta blockers such as propranolol
- B Calcium channel blockers such as diltiazem or amlodipine ✓
- C High-intensity statins
- D Ivabradine
Correct answer: B. Calcium channel blockers such as diltiazem or amlodipine
Explanation
This is variant (Prinzmetal) angina caused by reversible focal coronary vasospasm near an atherosclerotic plaque or in apparently normal segments. Calcium channel blockers and nitrates reduce spasm frequency and are first line. Non-selective beta blockade can worsen vasospasm by removing beta-2 mediated vasodilatation, leaving unopposed alpha tone. Statins and ivabradine do not address the spasm mechanism, though smoking cessation is essential adjunctive advice.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.