Prinzmetal angina
Pro Research Analysisby 
Searched over 200M research papers for "prinzmetal angina"
Consensus Meter
Understanding Prinzmetal Angina: Mechanisms, Diagnosis, and Treatment
Introduction to Prinzmetal Angina
Prinzmetal angina, also known as variant angina, is a type of chest pain caused by transient coronary artery spasms. Unlike typical angina, which is often triggered by physical exertion, Prinzmetal angina occurs at rest and is characterized by temporary reductions in blood flow due to spontaneous spasms of the coronary arteries .
Mechanisms of Coronary Artery Spasm
Alpha-Adrenergic Receptor Mediation
Research has shown that alpha-adrenergic receptors play a significant role in mediating coronary artery spasms. In a study involving patients with Prinzmetal angina, the administration of epinephrine and propranolol induced severe spasms in the right coronary artery, suggesting that these receptors are crucial in the pathogenesis of the condition.
Parasympathomimetic Agents
Another study demonstrated that parasympathomimetic agents like methacholine can induce anginal attacks by causing coronary artery spasms. This highlights the role of the parasympathetic nervous system in the development of Prinzmetal angina.
Endothelial Dysfunction
Endothelial dysfunction is also considered a primary factor in the development of Prinzmetal angina. This dysfunction leads to an imbalance in the regulation of vascular tone, contributing to the occurrence of coronary spasms.
Clinical Features and Diagnosis
Symptoms and Patient Demographics
Prinzmetal angina typically presents with chest pain at rest, often accompanied by ST-segment elevation on an electrocardiogram (ECG). The condition is more common in younger women who may not have traditional cardiovascular risk factors, except for cigarette smoking.
Diagnostic Tests
The diagnosis of Prinzmetal angina is primarily made by observing transient ST-segment elevation during an anginal attack. Ergonovine testing is considered the most sensitive and specific diagnostic test, where the administration of ergonovine induces coronary spasms, confirming the diagnosis.
Coronary Arteriography
Coronary arteriography is a valuable tool for documenting coronary artery spasms. Studies have shown that spasms can occur in both normal and diseased coronary arteries, and arteriography during an anginal attack can reveal the extent and location of the spasm .
Treatment Approaches
Medical Management
The primary treatment for Prinzmetal angina involves the use of vasodilator drugs such as nitrates and calcium channel blockers. These medications help to prevent and relieve coronary spasms . Beta-blockers and large doses of aspirin are contraindicated as they can exacerbate the condition.
Surgical Interventions
In cases where coronary spasms are superimposed on atherosclerotic lesions, coronary artery bypass grafting (CABG) combined with partial denervation of the heart has shown favorable outcomes. This approach is particularly beneficial for patients with significant coronary artery disease.
Prognosis
The prognosis for patients with Prinzmetal angina is generally good, especially in the absence of significant coronary artery stenosis. However, the presence of underlying coronary atherosclerosis can affect the overall prognosis, making the management of associated coronary artery disease crucial.
Conclusion
Prinzmetal angina is a unique form of angina characterized by coronary artery spasms that occur at rest. Understanding the mechanisms, clinical features, and effective treatment options is essential for managing this condition. With appropriate medical therapy and, in some cases, surgical intervention, patients with Prinzmetal angina can achieve a favorable prognosis.
Sources and full results
Most relevant research papers on this topic