title: [Many possible causes of variant angina].
abstract: BACKGROUND
  Variant angina, or vasospastic angina, is a form of angina caused by vasospasm of the coronary arteries, probably caused by endothelial dysfunction. This form of angina is provoked by non-classical risk factors such as stress, alcohol use, use of sympathomimetics and low environmental temperatures, but also by smoking. Treatment is based on elimination of risk factors and vasodilator therapy with nitrates and long-acting calcium antagonists.
  
  
  METHODS
  We present a 68-year-old woman with recurring thoracalgia at rest and during exercise, suggestive of severe variant angina in more than one coronary artery. Despite elimination of risk factors and administration of vasodilatory therapy the treatment was initially insufficient. It eventually emerged that the probable cause was frequent use of a vasoconstrictive nasal spray, although this was not described in literature, and not originally mentioned by the patient.
  
  
  CONCLUSIONS
  A thorough case history is of vital importance in a patient presenting with a history suggestive of variant angina. Even undescribed and apparently less important risk factors can be responsible for persistence of symptoms, and can lead to an applied treatment not producing the desired result.
authors.affiliation: Universiteit Gent, Faculteit Geneeskunde en Gezondheidswetenschappen, Gent, België.
authors.forename: Laurens
authors.initials: L
authors.lastname: Van de Bruaene
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Argacha
authors.forename: Peter
authors.initials: P
authors.lastname: Kayaert
authors.forename: Danny
authors.initials: D
authors.lastname: Schoors
authors.forename: Steven
authors.initials: S
authors.lastname: Droogmans
mesh_terms: D000788:Angina Pectoris, Variant / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D003329:Coronary Vasospasm / Q000139:chemically induced* / Q000150:complications; D003331:Coronary Vessels / Q000187:drug effects / Q000502:physiology; D005260:Female; D006801:Humans; D008875:Middle Aged; D014663:Nasal Decongestants / Q000008:administration & dosage / Q000009:adverse effects*; D014665:Vasodilator Agents / Q000627:therapeutic use*
chemical_list: D014663:Nasal Decongestants; D014665:Vasodilator Agents