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Another look at Prinzmetal's variant angina
European Journal of Cardiology
|October 1, 1977
Summary
Prinzmetal's angina may be a phase of atherosclerotic heart disease, not a separate condition. Coronary artery spasm causing complete vessel obstruction can lead to severe ischemia during these episodes.
Area of Science:
- Cardiology
- Vascular Biology
Background:
- Prinzmetal's variant angina is often considered distinct from atherosclerotic coronary artery disease.
- Understanding the underlying mechanisms of Prinzmetal's angina is crucial for effective patient management.
Observation:
- Two patients with Prinzmetal's angina presented with histories of classical angina.
- Both patients exhibited severe atheromatous lesions alongside coronary artery spasm leading to complete vessel occlusion during anginal attacks.
- Electrocardiographic ST segment elevations correlated with transmural ischemia due to transient coronary occlusion.
Findings:
- Coronary artery spasm can cause complete obstruction in patients with severe atherosclerotic lesions.
- Electrocardiogram changes during Prinzmetal's attacks indicate transmural ischemia.
- Milder anginal attacks showed non-specific ECG changes or T-wave inversions, suggesting less severe ischemia from milder spasm.
Implications:
- Prinzmetal's angina may represent a manifestation of underlying atherosclerotic disease rather than a separate entity.
- These findings suggest that coronary artery spasm can occur as a phase in the progression of atherosclerotic heart disease.
- Further research is warranted to explore the relationship between coronary spasm and atherosclerosis in angina patients.