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Variant forms of angina pectoris
Insights
Coronary artery spasm presents a wider clinical spectrum than previously known, affecting patients at rest and during exercise. Manifestations vary, impacting myocardial ischemia severity and diagnosis.
Area of Science:
- Cardiology
- Vascular Medicine
Background:
- Coronary artery spasm, a condition causing temporary narrowing of coronary arteries, can lead to myocardial ischemia.
- Prinzmetal's original description focused on specific clinical and electrocardiographic patterns.
Observation:
- Three patients with coronary artery spasm exhibited diverse clinical and electrocardiographic presentations.
- Anginal attacks occurred at rest in all patients; two also experienced exercise-induced angina without significant fixed coronary narrowing.
- Electrocardiogram (ECG) findings during pain included ST-segment elevation, ST-segment depression, or a combination.
Findings:
- Coronary angiography confirmed spontaneous or induced spasm in all three patients.
- Sublingual nitroglycerin (NTG) provided incomplete relief in two cases, questioning the interpretation of residual stenosis.
- The study demonstrates a broader clinical spectrum of coronary artery spasm than previously reported.
Implications:
- Clinical and ECG manifestations of coronary artery spasm are likely influenced by the spasm's location and severity.
- These variations can lead to different degrees of myocardial ischemia.
- Diagnostic approaches may need to consider the wide variability in spasm presentation.
Abstract:
3 patients with different clinical and electrocardiographic manifestations of coronary artery spasm are discussed. All 3 patients had anginal attacks at rest. In addition, 2 of these patients, who did not have significant preexisting narrowing of their coronary arteries, also had anginal pain related to exercise. During pain, 1 patient showed ST-segment elevation, the other ST-segment depression, while the third showed ST-segment depression shortly followed by ST-elevation on the electrocardiogram. At coronary angiography, spontaneous or induced spasm of one of the major coronary arteries could be demonstrated in all 3 patients. In 2 cases, sublingual nitroglycerin failed to completely relieve the spasm. This raises the question whether a residual stenosis after NTG conclusively proves a fixed organic narrowing. It is concluded that the clinical spectrum of spasm of the coronary arteries is wider than was originally reported by Prinzmetal and coworkers. Clinical and electrocardiographic manifestations are probably dependent on the site and severity of the spasm, which may cause different degrees of myocardial ischemia.