Cocaine use is most commonly associated with which type of angina?

• A. Stable angina
• B. Prinzmetal's angina
• C. Unstable angina
• D. Microvascular angina

Answer: (B)

Cocaine use triggers intense sympathetic stimulation that causes the coronary arteries to spasm. This sudden vasoconstriction leads to transient chest pain with features typical of vasospastic angina, known as Prinzmetal’s angina. The classic pattern is chest pain at rest with possible transient ST elevations, driven by reversible coronary vasospasm rather than fixed atherosclerotic narrowing.

Stable angina reflects exertional pain from a fixed plaque limiting flow, not a transient spasm. Unstable angina and other microvascular syndromes involve plaque rupture with thrombosis or microvascular dysfunction, not the prominent vasospasm seen with cocaine. Hence cocaine’s association is best with Prinzmetal’s angina. In management terms, vasodilators such as nitrates or calcium channel blockers are used, and beta-blockers are approached with caution in cocaine-associated chest pain.