Prinzmetal angina. Normal arteries and multifocal electrocardiographic changes

A 40-year-old man with severe angina had electrocardiographic changes typical of Prinzmetal angina during his attacks of chest pain. ST segment elevations in leads II, III, and aVF occurred intermittently with elevations in leads I and aVL, and with T wave flattening in V1, suggesting myocardial ischemia in areas supplied by the right coronary artery and by the circumflex branch of the left coronary artery. However, the coronary arteries appeared normal when arteriograms were made, suggesting that a reversible event caused the attacks.