Angina pectoris prinzmetal
Pro Research Analysisby 
Searched over 200M research papers
Consensus Meter
Understanding Prinzmetal's Angina Pectoris
Introduction to Prinzmetal's Angina Pectoris
Prinzmetal's angina, also known as variant angina, is a unique form of angina pectoris characterized by episodic chest pain that typically occurs at rest rather than during exertion. This condition is often associated with transient ST-segment elevation on an electrocardiogram (ECG) and is caused by a temporary spasm of a major coronary artery, leading to reduced blood flow to the heart muscle .
Pathophysiology and Clinical Features
Coronary Artery Spasm
The hallmark of Prinzmetal's angina is the transient spasm of a coronary artery, which can occur even in the absence of significant atherosclerotic plaques. This spasm leads to a temporary reduction in blood flow, causing myocardial ischemia and chest pain . The pain is often severe, can last longer than typical angina, and may follow a cyclic pattern, frequently occurring at the same time each day or night.
Electrocardiographic Changes
During an episode of Prinzmetal's angina, patients typically exhibit marked ST-segment elevation on the ECG, which is a sign of acute myocardial injury. This elevation is transient and resolves once the spasm subsides and normal blood flow is restored .
Hemodynamic and Symptomatic Presentation
Patients with Prinzmetal's angina may experience significant hemodynamic changes, including reductions in arterial pressure and cardiac index, along with increases in systemic peripheral resistance and pulmonary wedge pressure. These changes can occur even in the absence of angina symptoms, as demonstrated by continuous monitoring in some cases.
Diagnostic and Therapeutic Approaches
Diagnostic Tools
Diagnosis of Prinzmetal's angina often involves continuous ECG monitoring to capture transient ST-segment elevations and coronary arteriography to assess the presence of coronary artery spasms. In many cases, coronary arteries may appear normal or show minimal focal stenosis .
Calcium Antagonists
Calcium antagonists, such as nifedipine, diltiazem, and verapamil, are highly effective in preventing coronary artery spasms and reducing symptoms of ischemia in patients with Prinzmetal's angina. These medications work by reducing myocardial oxygen demand and preventing increases in coronary vasomotor tone . Studies have shown that nifedipine, in particular, can provide complete cessation of symptoms in patients who previously did not respond to other treatments.
Comparative Efficacy of Felodipine and Nifedipine
A study comparing the efficacy of felodipine and nifedipine in patients with Prinzmetal's angina found that both medications were similarly effective in reducing ischemic episodes and anginal attacks. Felodipine, administered once daily, provided 24-hour antiischemic protection and was associated with high patient compliance and improved quality of life.
Surgical Interventions
In cases where medical therapy is insufficient, surgical interventions such as intraaortic balloon pumping (IABP) and coronary artery bypass grafting (CABG) may be considered. These procedures can significantly reduce the frequency and intensity of anginal attacks, although they may not provide permanent relief. Postoperative administration of calcium antagonists can help maintain symptom control .
Conclusion
Prinzmetal's angina pectoris is a distinct clinical entity characterized by coronary artery spasms leading to transient myocardial ischemia and chest pain at rest. Effective management includes the use of calcium antagonists to prevent vasospasm and reduce symptoms. In refractory cases, surgical interventions may be necessary, with continued medical therapy to ensure long-term relief. Understanding the unique pathophysiology and treatment options for Prinzmetal's angina is crucial for optimizing patient outcomes.
Sources and full results
Most relevant research papers on this topic