Sudden death and variant angina.

Area of Science:

• Cardiology
• Clinical Medicine
• Pathophysiology

Background:

• Variant angina is characterized by rest chest pain and transient ST-segment elevation, typically due to coronary artery spasm.
• While often associated with atherosclerosis, variant angina can occur in individuals with unobstructed coronary arteries.
• Patients with variant angina and normal coronary arteries are generally considered to have a favorable prognosis.

Observation:

• This report details two distinct cases of sudden cardiac death.
• Both patients presented with variant angina and had angiographically normal coronary arteries.
• These cases represent a rare occurrence in the typical clinical presentation of variant angina.

Findings:

• Sudden cardiac death is an infrequent but possible outcome in patients with variant angina and normal coronary arteries.
• The absence of coronary artery obstruction does not preclude the risk of fatal cardiac events in variant angina.
• These findings suggest a need to reconsider the assumed benign nature of variant angina in the absence of atherosclerotic disease.

Implications:

• Clinicians should maintain a high index of suspicion for serious cardiac events even in variant angina patients with normal coronary arteries.
• Further research is warranted to elucidate the mechanisms underlying sudden cardiac death in this specific patient subset.
• Risk stratification strategies may need refinement for variant angina patients without obstructive coronary artery disease.