Prinzmetal angina is caused by artery spasm

DEAR DR. ROACH »

A recent column from a woman with recurrent chest pain and normal stress tests had me wondering: Could this be Prinzmetal angina?

— K.O.S. DEAR READER »

That’s an excellent question.

Vasospastic angina, also called variant angina or Prinzmetal angina, is caused by spasmodic constriction of the artery, often with blockages, but sometimes without any blockages at all. Smoking is one known risk factor for this condition. It was first described in 1959, and it is still underappreciated and underdiagnosed. Only about 2% of hospital admissions for suspected angina are due to vasospastic angina.

A major clue to vasospastic angina is the EKG taken at the time of the symptoms, which shows a finding (called “ST elevation”) that is commonly associated with an acute heart attack, but which goes away quickly once symptoms are gone. However, the findings can be missed and don’t occur in every patient.

Similarly, vasospastic angina may not show on the stress test. When the diagnosis is being considered, a very useful testing tool is ambulatory EKG monitoring, usually for one or two weeks. In combination with a compatible history and EKG findings, the ambulatory EKG monitoring can make the diagnosis.

Cardiac catheterization and angiography may be necessary to confirm the diagnosis. In some cases, experienced cardiologists will inject a small amount of a medication to try to provoke the spasm.

DEAR DR. ROACH » We are often instructed to wash our hands with soap. What kind of soap? Does it need to be antibacterial? What about soaps that are sodium lauryl sulfate-free?

— L.B.

DEAR READER » I do not recommend antibacterial soaps. The evidence shows they are no better than any other soap. They may also increase resistance, not only to the antibacterial agent in the soap, but to other antibiotics as well. Hence, the Food and Drug Administration removed the most commonly used antibacterial agents from most soaps and body washes in 2016.

Regular soap is very effective at removing bacteria and viruses from the hands through a mixture of washing them away and the action of the soap on the germs themselves. Some germs, such as the spores of C. diff, are highly resistant to soap, so it’s the washing away part that is critical, and that needs time and running water — at least 20-30 seconds.

Sodium lauryl sulfate is a common ingredient in soaps, and is very effective. However, it can be irritating to some people.