A case of misdiagnosed vasospastic angina in the last of us?

The Last of Us is a popular American series currently broadcasted on the subscription service Amazon Prime®. In a post-apocalyptic world, Joel (played by Pedro Pascal) is a hardened middle-aged survivor that has been tasked with smuggling a young girl, Ellie (Bella Ramsey), out of a quarantine zone and across the United States. In the sixth episode of the current first season, Joel suffers on two occasions of acute attacks that prompt him to suspend all activities. Attacks consist of anguished facial expression, possible chest pain (Joel clutches his chest on both occasions), breathlessness, and anxiety. Both occurred outdoor with exposure to wintery cold and after emotional stress during one. Anxiety is self-diagnosed due to the past traumatic history of the character. However, considering the data in hand, we believe that Joel could be presenting vasospastic angina. Arguments in favor include that he is a 50+ male, under - understandable but - permanent survival stress. Throughout the first episodes, we witness that he drinks regularly alcohol including beers and possibly stronger alcohols, unhealthy eating due to difficulties to find food, and outdoor exposure to harsh environment including cold and sleeping outdoor at nights. Recurrent emotional stress due post-traumatic stress disorder in relation to the violent death of his daughter and cold are plausible triggers of attacks. Arguments against include those attacks rather occurred in day times and no episode occurred during the night [ [1] Rehan R. Weaver J. Yong A. Coronary vasospastic angina: a review of the pathogenesis, diagnosis, and management. Life (Basel). 2022; 12: 1124 PubMed Google Scholar ]. We have also no knowledge of Joel's comorbidities, even thought he is most likely healthy as he has survived a 20-year-period of fungal pandemic.