A 70-year-old woman with a history of hypertension and CHD is experiencing episodes of chest pain at rest that wake her up from sleep. These episodes last 10 minutes and resolve spontaneously. Her ECG and cardiac enzymes are normal. What could be the diagnosis and the next steps?
This patient's symptoms are suggestive of variant (Prinzmetal's) angina, which is a form of angina pectoris that typically occurs at rest, often during sleep, and is due to coronary artery spasm. Even though her current ECG and cardiac enzymes are normal, an ECG during an episode might show transient ST-segment elevation. The patient should be started on calcium channel blockers or nitrates, which are the mainstays of therapy for variant angina.