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[Variant (Prinzmetal's) angina with diffuse coronary spasm without coronary sclerosis]
A Willberg1, G Lieb, D Nunberger
1III. Medizinische Klinik--Kardiologie, Klinikum Rudolf Virchow (Standort Wedding), Freie Universität Berlin.
Deutsche Medizinische Wochenschrift (1946)
|October 12, 1990
Summary
Variant angina, caused by coronary artery spasms, can trigger nocturnal angina and arrhythmias. The ergonovine test aids diagnosis when exercise ECGs are normal, with diltiazem and isosorbide dinitrate proving effective treatment.
Area of Science:
- Cardiology
- Vascular Medicine
- Clinical Electrophysiology
Background:
- Coronary artery spasm is a potential cause of angina and arrhythmias.
- Variant angina (Prinzmetal's angina) is characterized by dynamic obstruction of coronary arteries.
- Diagnosis can be challenging, especially with normal baseline investigations.
Observation:
- A 49-year-old man presented with escalating nocturnal angina and palpitations over three years.
- Exercise electrocardiogram (ECG) was negative; Holter monitoring showed ventricular arrhythmias with ST elevation.
- Coronary angiography revealed no atheroma, but diffuse spasm occurred post-ergonovine, inducing symptoms and arrhythmias.
Findings:
- The case confirmed spontaneous coronary artery spasm as the cause of angina and ventricular tachyarrhythmias.
- The ergonovine provocative test was crucial for diagnosing variant angina when standard tests were inconclusive.
- Treatment with diltiazem and isosorbide dinitrate effectively resolved spasms and symptoms.
Implications:
- Variant angina can manifest with typical symptoms and significant arrhythmias, even with normal exercise ECG and coronary angiograms.
- The ergonovine test is a valuable diagnostic tool for suspected coronary artery spasm.
- Pharmacological management with calcium channel blockers and nitrates can successfully control symptoms and prevent arrhythmias.