Prinzmetal angina: ECG changes and clinical considerations: a consensus paper
Antonio Bayés de Luna1, Iwona Cygankiewicz, Adrian Baranchuk
1Santa Creu i Sant Pau Hospital, Cardiovascular Research Center, CSIC-ICCC, Barcelona, Spain.
Summary
Prinzmetal angina involves ECG changes like peaked T waves and ST-segment elevation during coronary spasm. Arrhythmias, particularly ventricular ones, are common during these episodes.
Area of Science:
- Cardiology
- Clinical Electrophysiology
Background:
- Focuses on electrocardiogram (ECG) changes in Prinzmetal angina during proximal coronary artery spasm.
- Considers patients with normal or non-critical coronary artery stenosis.
Purpose of the Study:
- To detail the characteristic ECG manifestations of Prinzmetal angina.
- To correlate ECG findings with the occurrence and severity of arrhythmias.
Main Methods:
- Observational analysis of ECG patterns during episodes of coronary spasm.
- Correlation of specific ECG changes with arrhythmia prevalence and characteristics.
Main Results:
- Peaked, symmetrical T waves appear in ~50% of cases, followed by ST-segment elevation if spasm persists.
- Associated ECG changes include R-wave increase, S-wave decrease, TQ upsloping, and ST-T wave alternans.
- Ventricular arrhythmias are frequent and linked to episode duration, ST elevation, ST-T wave alternans, and R-wave changes.
Conclusions:
- Prinzmetal angina incidence has decreased due to treatments like calcium channel blockers and reduced smoking.
- ECG monitoring is crucial for diagnosing and understanding the risks associated with Prinzmetal angina episodes.
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