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Table 16. Diagnostic Criteria for Vasospastic Angina
Nitrate-responsive angina: during spontaneous episode, with at least 1 of the following :
• Rest angina, especially between night and early morning
• Marked diurnal variation in exercise tolerance, reduced in morning
• Hyperventilation can precipitate an episode
• Calcium channel blockers (not beta blockers) suppress episodes
Transient ischemic electrocardiographic changes: during spontaneous episode,
including any of the following in at least 2 contiguous leads:
• ST segment elevation ≥0.1 mV
• ST segment depression ≥0.1 mV
• New negative U waves
Coronary artery spasm: defined as transient total or subtotal coronary artery occlusion
(>90% constriction) with angina and ischemic electrocardiographic changes either
spontaneously or in response to a provocative stimulus (typically acetylcholine, ergot, or
hyperventilation)
"Definitive" vasospastic angina is diagnosed if nitrate-responsive angina is evident during
spontaneous episodes and either the transient ischemic ECG changed during the spontaneous
episodes or coronary artery spasm criteria are fulfilled.
"Suspected" vasospastic angina is diagnosed if nitrate-responsive angina is evident during
spontaneous episodes but transient ischemic electrocardiographic changes are equivocal or
unavailable and coronary artery spasm criteria are equivocal.
ECG indicates electrocardiogram.
Modified from Beltrame JF, et al. Eur Heart J. 2017;38:2565-2568 by permission of Oxford
University Press, copyright 2017, and by permission of e Author, copyright 2015.
