Variant angina induced by alcohol ingestion

Area of Science:

• Cardiology
• Pharmacology
• Neurology

Background:

• Prinzmetal's variant angina is a condition characterized by chest pain due to coronary artery spasms.
• Alcohol ingestion has been anecdotally linked to cardiac events, but specific triggers for variant angina are not well-established.

Observation:

• A 49-year-old man experienced nocturnal angina exclusively after evening alcohol consumption.
• His symptoms were consistently provoked by alcohol and absent without it, despite normal resting and exercise ECGs.
• Coronary arteriography showed moderate stenosis in the left anterior descending and left circumflex arteries.

Findings:

• Alcohol-induced nocturnal angina attacks were successfully provoked in this patient.
• The patient presented with ST elevation during anginal episodes, indicative of coronary spasm.
• Ethanol levels at the time of attack were low, suggesting a delayed effect rather than acute intoxication.

Implications:

• Autonomic nervous system imbalances secondary to alcohol's late effects may trigger coronary artery spasm.
• This case highlights alcohol as a potential trigger for Prinzmetal's variant angina.
• Further research is needed to understand the mechanisms linking alcohol, autonomic dysfunction, and coronary vasospasm.