PRINZMETAL ANGINA (VASOSPASTIC ANGINA, VARIANT ANGINA)

PRINZMETAL ANGINA is severe angina at rest , even asleep with transient ST-segment elevation. 

Myron Prinzmetal was an American cardiologist, who was the first to describe this type of angina. 

It occurs due to vasospasm, in contrast to stable angina pectoris, which occurs due to atherosclerosis.

It is characterized by a deterioration in the patient's condition from midnight to 8:00.


RISK FACTORS:

Smoking; 

Migraine and anti-migraine drugs; 

Raynaud syndrome; 

5-fluorouracil treatment;

Cyclophosphamide treatment;

Energy drinks;

Hyperventilation; 

Cold



COMPLICATIONS: 

Sudden death;

Myocardial infarction;

Ventricular tachycardia;

Ventricular fibrillation; 

Atrioventricular block;

 Asystole;


DIAGNOSIS:

ECG: depressions or elevations in ST segments;

Elevations of creatine kinase isoenzymes and troponin;

Coronary Angiography: Coronary spasm or multiple spasms on different vessels ; 

Diameter of right coronary artery>  left  coronary artery;



Provocative agents:

• Ergonovine provocation test: 0.05 to 0.2 mg IV

• Acetylcholine provocation test: 10-25-50-100 μg intracoronary; focal spasm during Prinzmetal angina


MANAGEMENT:

Smoking cessation; CCB (combination of dihydropyridine and nondihydropyridine PRN); Nitrates; Prazosin (alpha-blocking agent) and Nicorandil if necessary; Avoid nonselective Beta blockers risk of unopposed alpha stimulation); Avoid acetylsalicylic acid(inhibits prostacyclin synthesis);

PCI if associated stenosis; 

Mg2+ supplement; 

Statins may be beneficial; 

Defibrillator for secondary prevention (especially if ischemia persists despite treatment)



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