Vasospastic (Prinzmetal) Angina

Definition / Epidemiology:

 • Rest angina attributed to coronary artery vasospasm.

 • Patients often younger than other ACS patients.

 • Strong association with smoking and cocaine use.

 • Associated with other vasospastic disorders (Raynaud, migraine, etc.)

Pathophysiology:

 • Diffuse spasm of epicardial coronary artery.

 • Vascular smooth muscle hyper-reactivity of coronary arteries.

 • Imbalance of vagal and sympathetic tone may precipitate spasm.

 • Associations with endothelial dysfunction and microvascular injury.

Presentation:

 • Recurrent anginal chest pain

 • Episodes can be associated with ST segment changes.

 • Normal exercise tolerance

 • Pain is not positional

 • Variable troponin elevation

Diagnosis: 

 • Transient ST segment changes on tele/ECG that resolves with resolution of sx.

 • Can perform provocative tests in cath lab

Treatment: 

 • Smoking cessation

 • CCBs (prevent vasoconstriction, promote vasodilation

 • Nitrates?



By @NUIM_Chiefs



#Vasospastic #Prinzmetal #Angina #cardiology #diagnosis #management