Prinzmetal’s Variant Angina

Prinzmetal’s Variant Angina

Originally explained by Prinzmetal and associates.  The illness causes excruciating ischemia pain while at rest and is unrelated to physical activity.  ST segment elevation on the ECG.

Ischemic Heart Disease

• Individual with ischemia
• Individual with infarction.

Ischemia

• Stable Angina- Non-Specific ST-T changes
• Prinzmetal Angina- ST segment elevation
• Unstable Angina -  Non-Specific ST-T changes

Infarction

Based on ECG investigation

• Non-ST elevation MI
• ST elevation MI – ST segment elevation

Prinzmetal’s Angina

 Alternatively known as Vasospastic Angina. Because it is the result of a brief, focal spasm of the coronary artery (about 5 to 10 minutes),Transmural ischemia is the result of the myocardium receiving less blood due to this localized spasm.

Based on the artery implicated, aberrant ventricular function may develop.  Depending on the recurrence, either transmural ischemia or transmural infarction.

Because of the arrhythmogenic nature of the infarcted myocardium, people may have VF or VT. Palpitations, syncopal episodes, or abrupt cardiac death are examples of presentation.  Transient coronary vasospasm is more common in the right coronary artery.

The precise cause is unknown.  However, the cause may be the coronary artery smooth muscle's hypercontractility.
Leukotriene and serotonin are released as a result of the release of adrenergic vasoconstrictors.

Also Read: Comprehensive Guide Of Cardiac Pacemakers

Clinical Manifestations of Prinzmetal’s Angina

Pain in the chest; younger age group .Acute coronary syndrome is caused by:  Smoking;  Limited coronary risk factors.  Hypertension; Diabetes; Dyslipidemias; Associated Disorders,  Headaches, the Raynaud effect. Until there is an infarction, a cardiac examination will show normal results.

Left ventricular failure due to a large infarction:  S3 and S4  Lung rales on both sides.

Diagnosis of Prinzmetal’s Angina

Only in cases of chest discomfort does the patient's ECG exhibit transient ST segment elevation. Electrolyte abnormalities such as hyperkalemia and left bundle branch block are associated with ST segment elevation in the ECG. Ventricular aneurysms; acute pericarditis.

Confirmation of Diagnosis

Coronary Angiography: It should show evidence of momentary coronary vasoconstriction. The diagnosis of Prinzmetal angina is characterized by it. Atherosclerotic plaque spread over the whole vessel. It must exist in one or more of the coronary arteries' proximal regions. 

Also Read: Rapid Acquisition Of Key Concepts - Cardiovascular

Demonstration of Coronary Artery Vasospasm 

Ask the patient to perform hyperventilation during the coronary angiography, and administer intracoronary acetylcholine; this has been demonstrated to cause focal coronary artery stenosis.
In the case of a suspected coronary vasomotor anomaly and no obstructive lesion, or coronary artery atherosclerotic plaque, a provocative test for spasm has been demonstrated to be safe to be used during a coronary angiogram.

Treatment                            

Preferred medication: nitrates. PDE 5 inhibitors, such as sildenafil; Calcium channel blockers, such as verapamil or diltiazem.  Avoiding aspirin is advised.  Because it may result in changes to prostacyclin levels, which may impact the coronary tone's sensitivity.

HMG CoA reductase inhibitors as a statin treatment   Its action is pleiotropic.  Lowers the likelihood of significant events.
Regarded as the preferred medication for long-term stable angina, although Prinzmetal angina response varies.
Patients with discrete vasospasm flow limiting proximal fixed obstructive lesions benefit from invasive therapy and coronary revascularization. The use of implantable cardioverter defibrillators (ICDs).

Prognosis

Acute, active, and recurrent episodes of angina will occur within six months of the initiation of Prinzmetal angina.
Prinzmetal angina symptoms go away after six months.
At five years, 90–95% of people have good survival rates, whereas only 20% will suffer a myocardial infarction.

Patients with Prinzmetal angina who do not have a coronary artery blockage are at a lower risk of MI or sudden cardiac death than those who do.  The best candidates for an ICD are those with Prinzmetal angina who experience spontaneous episodes of pain and develop VT/VF. These individuals are also more likely to experience sudden cardiac death.

There is a tendency for symptoms to improve over time or for the number of cardiac events to decrease in the majority of individuals who survive myocardial infarction or who experience frequent episodes over the first six months.

Also Read: High-Yield Image Based Question on ECG

Hope you found this blog helpful for your NEET SS Medicine Cardiovascular Preparation. For more informative and interesting posts like these, keep reading PrepLadder’s blogs.