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Chapter: Medicine and surgery: Cardiovascular system

Variant/Prinzmetal’s angina - Ischaemic heart disease

Angina of no obvious provocation not as a direct result of atheroma.- Definition, Incidence, Age, Sex, Aetiology, Pathophysiology, Clinical features, Complications, Investigations, Management, Prognosis.

Variant/Prinzmetal’s angina

 

Definition

 

Angina of no obvious provocation not as a direct result of atheroma.

 

Aetiology/pathophysiology

 

Caused by spasm of a coronary artery most often without atheroma or in association with a mild eccentric lesion. The reason for spasm occurring is unknown.

 

Clinical features

 

Pain is usually more severe and more prolonged than classical angina occurring at rest particularly in the early morning.

Complications

 

Arrhythmias may occur in the ischaemic episode (usually heart block and ventricular tachycardia), and very rarely the ischaemia may result in myocardial infarction.

 

Investigations

 

ECG shows characteristic ST elevation during an attack.

 

Management

 

Nitrates and calcium antagonists are useful as prophylaxis and as acute treatment. β-blockers tend to increase coronary tone and hence exacerbate the angina. It may be necessary to treat the arrhythmias provoked by the spasm.

 

Surgical treatment is rarely necessary or possible.

 

Prognosis

 

The prognosis in patients with angina without underlying heart or metabolic disease is very good.

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Medicine and surgery: Cardiovascular system : Variant/Prinzmetal’s angina - Ischaemic heart disease |


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