Prinzmetal's angina; variant angina; coronary vasospasm
Jump to navigation
Jump to search
Etiology
Epidemiology
- 50% of patients with acute coronary syndrome without coronary artery occlusion (by angiography)
- young women with migraine headaches[5]
- often occurs in cigarette smokers
Pathology
- often occurs at a site of an insignificant coronary plaque
- a majority of patients with variant angina have angiographically significant CAD
Clinical manifestations
- pain that is not precipitated by cardiac work, is of longer duration, is usually more severe
- frequently occurs at night in bed.
Laboratory
- no elevation of CK MB or troponin-I
Diagnostic procedures
- electrocardiogram:
- ST segment depression
- unusual ECG manifestations including ST segment elevation in leads that are normally depressed in typical angina (ECG leads V1-V4)[6]
- resolution of ST segment elevation with nitroglycerin[6]
Radiology
- coronary angiography
- transient vasospasm occuring spontaneously or
- following provocative stimuli
- intravenous ergonovine
- intracoronary acetylcholine
- hyperventilation
Complications
Management
- acute attacks
- sublingual nitroglycerin
- short-acting nifedipine
- chronic management
- long-acting nitrates
- long-acting Ca+2 channel antagonists
- beta blockers of little value
- prazosin may be useful
- surgical revascularization if severe discrete obstructive lesions
More general terms
References
- ↑ Stedman's Medical Dictionary 26th ed, Williams & Wilkins, Baltimore, 1995
- ↑ Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 1374
- ↑ Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 90-91
- ↑ Ong P et al. Coronary artery spasm as a frequent cause of acute coronary syndrome: The CASPAR (Coronary Artery Spasm in Patients With Acute Coronary Syndrome) study. J Am Coll Cardiol 2008 Aug 12; 52:523. PMID: https://www.ncbi.nlm.nih.gov/pubmed/18687244
Pepine CJ. Provoked coronary spasm and acute coronary syndromes. J Am Coll Cardiol 2008 Aug 12; 52:528. PMID: https://www.ncbi.nlm.nih.gov/pubmed/18687245 - ↑ 5.0 5.1 Medical Knowledge Self Assessment Program (MKSAP) 14, American College of Physicians, Philadelphia 2006
- ↑ 6.0 6.1 6.2 NEJM Knowledge+
de Luna AB, Cygankiewicz I, Baranchuk A et al Prinzmetal angina: ECG changes and clinical considerations: a consensus paper. Ann Noninvasive Electrocardiol. 2014 Sep;19(5):442-53. PMID: https://www.ncbi.nlm.nih.gov/pubmed/25262663 PMCID: PMC6932094 Free PMC article. Review.