STEPUP Cardiovascular System: Ischemic Heart Disease - Variant (Prinzmetal) Angina

Question 1

What does variant (prinzmetal) angina involve?

Answer 1

It involves transient coronary vasospasm that usually is accompanied by a fixed atherosclerotic lesion but can also occur in normal coronary arteries

Question 2

When does prinzmetal angina occur and what is it associated with?

Answer 2

Episodes of angina occur at rest and are associated with ventricular dysrhythmias, some of which may be life threatening. The angina classically occurs at night

Question 3

What is the hallmark on ECG for prinzmetal angina?

Answer 3

Hallmark is transient ST segment elevation (not depression) on ECG during chest pain, which represents transmural ischemia

Question 4

What is the definitive test for prinzmetal angina and how is it done?

Answer 4

Coronary angiography is a definitive test - displays coronary vasospasm when the patient is given IV ergonovine or acetylcholine (to provoke vasoconstriction)

Question 5

Are vasodilators helpful in the treatment of prinzmetal angina? What risk factor modification is helpful?

Answer 5

1) Vasodilators - calcium channel blockers and nitrates have been proven to be helpful
2) Risk factor modification including smoking cessation and lipid lowering is also indicated where appropriate