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Prinzmetal Variant Angina

Prinzmetal%27s Variant Angina


Presentation

  • […] elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC).[empendium.com]
  • We describe the case of a patient with vasospastic disease whose clinical presentation simulates a heart attack and after diagnostic studies that allowed dismiss this and, the proper treatment was given.[scielo.org.co]
  • Patient who present with this kind of angina is a challenge to an astute emergency physician. These patients may present with non-specific symptoms and can be easily missed in the absence of awareness amongst emergency physician.[casereports.in]
  • […] sclerosis (MS) is typically a relapsing-remitting neurologic disorder involving demyelinated plaques, which slow or block conduction along nerves. 3 Literature search reveals one case report indicating a causal relationship between these 2 diseases. 4 We present[jabfm.org]
  • Discussion Previous studies have suggested that the pathogenesis of Prinzmetal’s vasospastic angina may be similar to that of bronchial asthma, as we see in the presentation of this young patient.[academic.oup.com]
Physician
  • PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians[empendium.com]
  • Patient who present with this kind of angina is a challenge to an astute emergency physician. These patients may present with non-specific symptoms and can be easily missed in the absence of awareness amongst emergency physician.[casereports.in]
  • See also Heberden's disease (Heberden's asthma), under William Heberden, English physician, 1710-1801. Bibliography M. Prinzmetal, R. A Massumi: The anterior chest wall syndrome-chest pain resembling pain or cardiac origin.[whonamedit.com]
  • Electrophysiology, Alaska Heart Institute, Providence and Alaska Regional Hospitals Steven J Compton, MD, FACC, FACP is a member of the following medical societies: Alaska State Medical Association, American College of Cardiology, American College of Physicians[emedicine.medscape.com]
Intravenous Administration
  • Impaired endothelium-dependent vasodilation in the brachial artery in variant angina pectoris and the effect of intravenous administration of vitamin C. Am J Cardiol 2001; 87(10): 1154-1159.[cathlabdigest.com]
  • The onset of symptom relief in response to intravenous administration, which is used in more severe attacks of angina, occurs almost immediately while sublingual formulations of it act within 1–5 minutes.[en.wikipedia.org]
Dyspnea
  • Other associated symptoms may include nausea, diaphoresis, palpitations, dyspnea, and lightheadedness.[empendium.com]
  • Such chest “discomfort” may be accompanied by dyspnea, nausea, or sweating, and/or palpitations. These symptoms often persist for 15 minutes or more.[verywellhealth.com]
Nausea
  • The patient had been admitted 2 days earlier with nausea, vomiting, and abdominal pain after starting an oral prednisone taper for a recent MS exacerbation.[jabfm.org]
  • Other associated symptoms may include nausea, diaphoresis, palpitations, dyspnea, and lightheadedness.[empendium.com]
  • Symptoms Angina symptoms include: Chest pain or discomfort, possibly described as pressure, squeezing, burning or fullness Pain in your arms, neck, jaw, shoulder or back accompanying chest pain Nausea Fatigue Shortness of breath Sweating Dizziness These[mayoclinic.org]
  • Other symptoms associated include: Pain in your arms, neck, jaw, shoulders and back and on top of chest pain Shortness of breath Nausea Fatigue Sweating Dizziness It is vital to understand what type of chest discomfort you are experiencing and identify[victorchang.edu.au]
  • Such chest “discomfort” may be accompanied by dyspnea, nausea, or sweating, and/or palpitations. These symptoms often persist for 15 minutes or more.[verywellhealth.com]
Abdominal Pain
  • The patient had been admitted 2 days earlier with nausea, vomiting, and abdominal pain after starting an oral prednisone taper for a recent MS exacerbation.[jabfm.org]
  • Women may also experience symptoms such as: Nausea Shortness of breath Abdominal pain Discomfort in the neck, jaw or back Stabbing pain instead of chest pressure When to see a doctor If your chest pain lasts longer than a few minutes and doesn't go away[mayoclinic.org]
Vomiting
  • The patient had been admitted 2 days earlier with nausea, vomiting, and abdominal pain after starting an oral prednisone taper for a recent MS exacerbation.[jabfm.org]
  • […] a few minutes Pain extending beyond your chest to your shoulder, arm, back, or even to your teeth and jaw Increasing episodes of chest pain Prolonged pain in the upper abdomen Shortness of breath Sweating Impending sense of doom Fainting Nausea and vomiting[mayoclinic.org]
Chest Pain
  • Keywords : Prinzmetal's variant angina; Chest pain; Vasoespastic disease.[scielo.org.co]
  • Chest pain generally occurs at rest and usually in the absence of flow-limiting coronary stenoses.[empendium.com]
  • Although the chest pain of Prinzmetal’s angina results from myocardial ischemia, the syndrome differs from the classical form of angina pectoris in many respects.[ajronline.org]
  • The patient denied any previous episodes of chest pain as well as any cardiac history, hypertension, hypercholesterolemia, or respiratory problems.[jabfm.org]
  • Although angina is relatively common, it can still be hard to distinguish from other types of chest pain, such as the pain or discomfort of indigestion. If you have unexplained chest pain, seek medical attention right away.[mayoclinic.org]
Tachycardia
  • Variant angina complicated by polymorphic ventricular tachycardia. Int J Cardiol 2010;145:e47–49.[eplabdigest.com]
  • Single channel Holter recording during syncope showing normal ST segment (1) and ST segment elevation (2); during ST segment elevation severe ventricular arrhythmias were detected (transient ventricular tachycardia and fibrillation).[tandfonline.com]
  • Prinzmetal’s angina is associated with significant arrhythmia, such as second or third degree arterio-venous (A-V) block, ventricular tachycardia, ventricular fibrillation, and asystole. 2,3,4 A 24-48 hour Holter monitor study can be very definitive in[cathlabdigest.com]
  • The most common ECG feature is ST-segment elevation. 1 In 25% of cases these alterations are followed by various types of arrhythmia, including ventricular extrasystoles, ventricular tachycardia, ventricular fibrillation (rare), AVB or supraventricular[revportcardiol.org]
  • Prolonged spasm can cause acute coronary syndrome, fatal arrhythmias like ventricular fibrillation, ventricular tachycardia, complete atrio-ventricular block and electromechanical dissociation [ 6 ].[casereports.in]
Palpitations
  • Other associated symptoms may include nausea, diaphoresis, palpitations, dyspnea, and lightheadedness.[empendium.com]
  • Which may be similar to typical angina, tightness in the chest, pressure, shortness of breath, sweating or palpitations. And unlike typical angina which usually occurs during exertion, Prinzmetal usually happens when a person is at rest.[abc12.com]
  • The chest pain may: occur at rest or wake the patient from sleep be accompanied by dyspnoea and/or palpitations be triggered by exertion; there is variability in the workload required to precipitate pain The presumptive diagnosis of variant angina is[gpnotebook.co.uk]
  • He did not report any loss of consciousness, seizure, chest pain or palpitations. Patient was a known hypertensive, end-stage renal disease on maintenance hemodialysis and prospective renal allograft recipient.[casereports.in]
  • Such chest “discomfort” may be accompanied by dyspnea, nausea, or sweating, and/or palpitations. These symptoms often persist for 15 minutes or more.[verywellhealth.com]
Hypertension
  • The patient denied any previous episodes of chest pain as well as any cardiac history, hypertension, hypercholesterolemia, or respiratory problems.[jabfm.org]
  • Observation : It is a 64 years old patient, hemophilia A major, chronic smoking (40 pack-year), not diabetic, not hypertensive, which had a retro sternal constrictive pain radiating to the shoulders. At admission he was consciousness.[bloodjournal.org]
  • The incidence of coronary spasm nowadays appears to be decreasing because of treatments to reduce recurrences, the use of calcium channel blockers in hypertension and coronary artery disease, and the reduction in tobacco use.[cardiocases.com]
  • Patient was a known hypertensive, end-stage renal disease on maintenance hemodialysis and prospective renal allograft recipient. Electrocardiogram (ECG) and echocardiography done as part of pre-anaesthetic check-up revealed no abnormalities.[casereports.in]
  • Angina may be precipitated or worsened by coexisting conditions such as poorly controlled hypertension (HTN), anemia, or thyrotoxicosis. 4 Angina may be classified into three major types: stable, or effort, angina; unstable angina; and Prinzmetal’s, or[uspharmacist.com]
Heart Block
  • Abstract A woman with Prinzmetal angina displayed spontaneous attacks of myocardial ischemia characterized by severe chest pain, hypotension, inferior-wall ST-segment elevation and transient complete heart block.[nejm.org]
  • A prolonged attack may lead to ventricular arrhythmia, myocardial infarction, heart block, and sudden death. See also Heberden's disease (Heberden's asthma), under William Heberden, English physician, 1710-1801. Bibliography M. Prinzmetal, R.[whonamedit.com]
  • Bradyarrhythmias are found to be more common in cases of inferior ST segment elevation, 4 ventricular arrhythmias in anterior ST elevation, and lethal arrhythmias, such as ventricular fibrillation and advanced heart block are usually seen in cases of[academic.oup.com]
  • Prolonged vasospasm may lead to ventricular arrhythmias, heart block, or death. 8 Other: In addition to the forms of angina described above, patients may experience a n gina decubitus, also called nocturnal angina.[uspharmacist.com]
Dizziness
  • Other symptoms associated include: Pain in your arms, neck, jaw, shoulders and back and on top of chest pain Shortness of breath Nausea Fatigue Sweating Dizziness It is vital to understand what type of chest discomfort you are experiencing and identify[victorchang.edu.au]
  • Sit or lie down before using your spray or tablet, because it can make you dizzy. Use the smallest dose you normally take (e.g. a full, half, or even quarter of a tablet). Wait 5 minutes.[heartfoundation.org.au]
  • The patient noted dizziness and diaphoresis during these episodes.[eplabdigest.com]
  • Nearly 10% of patients are unable to tolerate nitrates because of disabling headaches or dizziness.[uspharmacist.com]
  • Symptoms Angina symptoms include: Chest pain or discomfort, possibly described as pressure, squeezing, burning or fullness Pain in your arms, neck, jaw, shoulder or back accompanying chest pain Nausea Fatigue Shortness of breath Sweating Dizziness These[mayoclinic.org]
Seizure
  • Other drugs such as long-acting nitrates, nicorandil, certain antioxidants and fluvastatin may also have a favorable effect on the prevention of seizures. Sublingual nitroglycerine helps to relax the spasm when it occurs.[cardiocases.com]
  • Past medical history included MS, depression, possible seizure disorder, tonsillectomy, and appendectomy. She was adopted, and her family history is unknown.[jabfm.org]
  • As witnessed by the spouse, the patient turned blue and had transient seizure-like activity. EKG in the field showed less than 1 mm of ST elevation in II, III, and aVF, and some flattening of the ST segment in the anterior precordial leads.[eplabdigest.com]
  • He did not report any loss of consciousness, seizure, chest pain or palpitations. Patient was a known hypertensive, end-stage renal disease on maintenance hemodialysis and prospective renal allograft recipient.[casereports.in]
Paresthesia
  • Evaluation of lower extremity paresthesias led Lalouschek et al 4 to a diagnosis of multiple sclerosis; multiple white matter lesions of the head and thoracic spinal cord were evident on MRI.[jabfm.org]

Workup

  • Prinzmetal variant angina is characterized by angina secondary to coronary artery vasospasm, 1 typically at rest, associated with transient ST-segment deviations. 2 Further diagnostic workup using angiography may reveal coronary arteries with or without[jabfm.org]
  • The initial workup should be to evaluate the possibility of fixed obstructive coronary artery disease. If appropriated, a noninvasive stress test can be performed. Most of these patients will have a normal stress test or negative for ischemia.[statpearls.com]
  • Hence, the coronary angiography is usually part of the workup of these patients and can help to guide the treatment 4,6. Treatment Nitrates and calcium channel blockers are the main treatments for patients with variant angina.[scielo.br]
Hypercholesterolemia
  • The patient denied any previous episodes of chest pain as well as any cardiac history, hypertension, hypercholesterolemia, or respiratory problems.[jabfm.org]
White Matter Lesions
  • Although her spinal cord was not imaged, head MRI revealed multiple white matter lesions; at least 2 lesions were acute.[jabfm.org]

Treatment

  • Drugs such as calcium antagonists and nitrates are the mainstays of treatment. The spasms tend to come in cycles – appearing for a time, then going away. After six to 12 months of treatment, doctors may gradually reduce the medication.[heart.org]
  • Prinzmetal variant angina is an uncommon disease in Colombia, it have high risk of complications if is not diagnosed early and a rapid treatment starter.[scielo.org.co]
  • Treatment Top Medical Treatment 1. Modification of risk factors, particularly smoking cessation. 2. High-dose oral calcium channel blockers : Diltiazem 120 to 360 mg/d, verapamil 240 to 480 mg/d ( Table. Typical dosage of beta-blockers and… ).[empendium.com]
  • Treatment with calcium channel blockers prevented recurrence of chest pain.[cardiocases.com]
  • Read how Jennifer Waller (pictured above) has got her life back after getting treatment for microvascular angina.[bhf.org.uk]

Prognosis

  • Prinzmetal's angina is a chronic condition that will need to be followed by your healthcare provider even though the prognosis is generally good. Track your angina symptoms with our Angina Log.[heart.org]
  • The prognosis is good when there is no significant coronary artery stenosis. Treatment of associated coronary atherosclerosis in elderly patients with PVA is advised.[ncbi.nlm.nih.gov]
  • Long-term prognosis of "variant" angina with medical treatment. Severi S, Davies G, Maseri A, Marzullo P, L'Abbate A: Am J Cardiol 1980, 46:226-232. 15. Long-term prognosis of patients with variant angina.[escardio.org]
  • Spasm provocation tests are ways of diagnosing vasospastic angina and assessing its prognosis.[omicsonline.org]
  • Long-term prognosis for patients with variant angina and influential factors. Circulation. 1988 Jul. 78(1):1-9. [Medline]. Onaka H, Hirota Y, Shimada S, et al.[emedicine.medscape.com]

Etiology

  • Etiology and Pathogenesis The etiology of this condition is not well-understood; however, inappropriate vasospasm occurs in segments of apparently health coronary artery.[pathwaymedicine.org]
  • These symptoms are attributed to coronary arteries spasm. [1] [2] Etiology Diffuse or segmental spasm in the coronary arteries causes Printzmetal angina. There is a decrease in blood supply to the myocardium generating symptoms like chest pain.[statpearls.com]
  • Introduction Syncope is a common entity and its etiology is often difficult to determine, even after comprehensive investigation.[tandfonline.com]
  • It is unclear the incidence of sudden cardiac death related to this phenomenon, but this should be thought after as an etiology for patients presenting with chest pains prior to their cardiac arrest or prior to their syncope.[eplabdigest.com]

Epidemiology

  • Epidemiology of multiple sclerosis. Neurol Clin 1996 ; 14 : 291 –308. Mayer S, Hillis LD. Prinzmetal’s variant angina. Clin Cardiol 1998 ; 21 : 243 –6. View Abstract[jabfm.org]
  • The epidemiology of migraine.. Am J Med., 118 (2005), pp. S3-S10 [2] Kurth T, Gaziano JM, Cook NR, Logroscino G, Diener HC, Buring JE.. Migraine and risk of cardiovascular disease in women..[revespcardiol.org]
  • Recreational drug use, for example, cocaine use, is associated with the development of vasospastic angina, especially when used concurrently with cigarette smoking. [3] Epidemiology Incidence or prevalence of Prinzmetal angina is still unknown.[statpearls.com]
  • An epidemiologic review. Headache. 2004 May. 44 Suppl 1:S5-12. [Medline]. Hirano Y, Uehara H, Nakamura H, et al.[emedicine.medscape.com]
Sex distribution
Age distribution

Pathophysiology

  • There are multiple precipitating factors that play a role in the pathophysiology of Prinzmetal’s angina.[eplabdigest.com]
  • Migraine aura pathophysiology: the role of blood vessels and microembolisation.. Lancet Neurol., 9 (2010), pp. 309-317 [6] O’Keeffe ST, Tsapatsaris NP, Beetham WP..[revespcardiol.org]
  • Abstract Since the pathophysiologic mechanism inducing coronary artery spasm is poorly understood, both medical and surgical therapy remain empirical.[mdedge.com]
  • Conclusion Despite differing pathophysiology, this study shows an increased risk of having Prinzmetal angina in patients with known cardiovascular risk factors.[onlinejacc.org]
  • The pathophysiology explaining the hyperactivity of the coronary smooth muscle cells is still poorly defined although many mechanisms are likely involved: genetic factors (increased incidence in Asia, less in Europe), oxidative stress, inflammation, etc[cardiocases.com]

Prevention

  • […] of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive[empendium.com]
  • Further studies would be helpful to clarify whether or not there is a relationship between these 2 diseases and might lead to prevention of chest pain and other forms of cardiovascular morbidity through prophylactic treatment of patients at risk.[jabfm.org]
  • Our Specialty Centers The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease takes a multidisciplinary approach to helping you prevent heart disease and stroke—and that includes getting your cholesterol in check.[hopkinsmedicine.org]
  • […] help prevent angina: No smoking Eat a healthy diet Regular physical exercise Maintain a healthy weight Reduce stress level Monitor and control conditions such as high blood pressure, high cholesterol and diabetes Research into Angina[victorchang.edu.au]
  • The difficulty to prevent new episodes of sudden death is also stressed by Meisel et al. ( 5 Meisel SR, Mazur A, Chetboun I, Epstein M, Canetti M, Gallimidi J,.[tandfonline.com]

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