Prinzmetal angina

• Prinzmetal angina:

  • Also called variant angina or coronary artery vasospasm
  • Reversible vasoconstriction driven by a spontaneous vascular smooth muscle contractility
  • Most patients also have underlying coronary artery disease but some have normal arteries
• Triggers:

  • Usually happen in the morning - time when spontaneous spasm is most likely to occur
  • Physical or mental stress
  • Alcohol
  • Cocaine
  • Beta-blockers
• Symptoms:

  • Occurs at rest
  • Usually last 5-30 minutes
  • Most episodes occur between midnight and early morning - can wake the patient up
  • Any episode can result in myocardial ischaemia, life-threatening arrhythmias and sudden death
• Investigations:

  • Very hard to distinguish from ACS so hospital assessment needed
  • Troponin
  • ECG - transient ST changes during the attack, resolves spontaneously after attack or after GTN
  • Gold standard = coronary angiography - give provocative agent
• Management:

  • Manage lifestyle factors - smoking, alcohol
  • Manage any co-existing CAD
  • Nitrates
  • CCB
  • AVOID BETA BLOCKERS - MAY AGGREVATE SPASM
  • ICD may be needed in patients who have survived previous VT/VF
  • Coronary artery stenting for refractory spasm
  • Coronary revascularisation may be required for associated stenosis due to CAD
• Complications:

  • MI
  • Arrhythmias
  • Hart failure
  • Sudden cardiac death