Prinzmetal's angina pectoris

Prinzmetal's angina pectoris (variant AP, vasospastic AP, angina pectoris inversa) is a specific type of angina pectoris.

  • Occurs as a result of 'spasm of epicardial coronary vessels (spasm can affect two or more coronary vessels at the same time).
  • On EKG we observe transient ST segment elevation'.

It was first described in 1959 by the American cardiologist Myron Prinzmetal.[1]

Etiopathogenesis

Prinzmetal's AP

Vasoconstrictive stimulus (histamine, serotonin, ergonovine, acetylcholine, noradrenaline, blood pH) + local hyperreactivity of coronary arteries to vasoconstrictive stimulus → epicardial spasm coronary arteries.[2][3]

Most coronary spasms are clinically manifested as angina pectoris and resolve spontaneously. However, longer-lasting spasms can result in myocardial infarction, arrhythmia or sudden cardiac death.[3]

Clinical symptoms

A typical symptom is angina. Their occurrence is often significantly higher depending on the weather and season; they are more common in autumn and winter in dry weather. Prinzmetal's AP can also cause a variety of arrhythmias' (from AV block to ventricular fibrillation).[3]

Diagnosis[2][3]

ST elevation is measured at the so-called J-point
  • Prinzmetal's AP is not tied to physical activity. Angina occurs most often at night (median is 4 am).
  • During an episode of angina, we observe ST elevation (or ST depression, inversion or pseudonormalization of the T wave) on the ECG. Holter monitoring can be used to capture ST elevation.
  • Provocation tests: provocation with acetylcholine, methacholine, methylergonovine; provocation by exercise, cold, hyperventilation (hyperventilation echocardiography – the patient is allowed to hyperventilate during the echocardiography, which can initiate a coronary spasm, which is subsequently manifested by a disturbance in the kinetics of the ischemic region of the myocardium).

In the case of a negative coronary angiographic examination, ST elevation capture during the attack is sufficient for the diagnosis of Prinzmetal's AP.

Treatment

Pharmacological therapy is similar to classical AP. Antiplatelet therapy is controversial.



References

  1. ↑ PRINZMETAL, M – KENNAMER, R – MERLISS, R. Angina pectoris. I. A variant form of angina pectoris; preliminary report. Am J Med [online]. 1959, vol. 27, p. 375-88, Available from <https://www.ncbi.nlm.nih.gov/pubmed/14434946>. ISSN 0002-9343. 
  2. ↑ a b FEDORCO, Marian. , et al. Variant (Prinzmetal's) angina as a less frequent cause of cardiac syncope. Cor et Vasa. 2008, y. 50, vol. 9, p. 348-351, ISSN 1803-7712. 
  3. ↑ a b c d ROCK, T .. , et al. Malignant arrhythmia in a patient with variant (Prinzmetal's) angina pectoris. Inside Medicine. 2007, y. 53, vol. 6, p. 724-728, ISSN 0042-773X. 

References

  • ASCHERMANN, Michael, et al. Cardiology. 1. edition. Prague : Galen, 2004. vol. 2. pp. 1183-1185. ISBN 80-7262-290-0.


  • VOKURKA, Martin. The Great Medical Dictionary. 8. edition. Prague : Maxdorf, 2009. 1143 pp. ISBN 978-80-7345-166-0.