Prinzmetal angina is caused by:

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Prinzmetal angina is driven by sudden, reversible narrowing of a coronary artery due to vasospasm. During an attack, the spasm briefly reduces blood flow enough to cause transmural ischemia, which shows up as chest pain and transient ST-segment elevation on the ECG. This pattern is distinct from angina caused by fixed narrowing from atherosclerotic plaque, where pain is typically exertional and the obstruction remains, not transient. It’s also different from events caused by plaque rupture with thrombosis, which lead to acute coronary syndromes rather than purely vasospastic episodes. The defining feature is the reversible coronary vasospasm, often occurring at rest and sometimes linked to endothelial dysfunction or triggers like smoking. Treatments that prevent or relieve the spasm, such as calcium channel blockers and nitrates, are effective because they directly counteract the vasoconstriction.