Syncope in association with Prinzmetal variant angina

Area of Science:

• Cardiology
• Clinical Medicine
• Vascular Biology

Background:

• Prinzmetal variant angina is a condition characterized by coronary artery vasospasm.
• Myocardial infarction (MI) can present with complex arrhythmias and hemodynamic instability.

Observation:

• A case of anteroseptal myocardial infarction complicated by Prinzmetal variant angina, transient complete atrioventricular block, and syncopal episodes is presented.
• Demand cardiac pacing failed to prevent syncopal attacks, indicating a non-bradycardia-related mechanism.

Findings:

• Severe left ventricular ischemia, leading to reduced cardiac output, is hypothesized as the cause of syncope.
• Coronary angiography revealed high-grade proximal obstruction in the left anterior descending artery and suggested right coronary artery spasm as the cause of anginal episodes.
• Two-hourly coronary arterial vasodilator therapy successfully prevented recurrent anginal episodes.

Implications:

• This case highlights the potential for coronary artery spasm to cause severe complications, including syncope and atrioventricular block, following myocardial infarction.
• Effective management of Prinzmetal variant angina with vasodilators is crucial in post-MI patients.
• Understanding the interplay between myocardial infarction, coronary vasospasm, and arrhythmias is vital for clinical practice.