Presentation
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]
[…] 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]
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]
The crisis starts when the coronary spasm presents lower ST ascent than after the crisis (see arrow). [onlinelibrary.wiley.com]
Entire Body System
- Intravenous Administration
Despite initial improvement following intravenous administration of atropine and sublingual administration of nitroglycerin she died of cardiogenic shock. [cmaj.ca]
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]
Cardiovascular
- Chest Pain
Keywords : Prinzmetal's variant angina; Chest pain; Vasoespastic disease. [scielo.org.co]
Remember that many types of chest pain aren’t related to angina at all. For example, heartburn, injury, or inflammation of the lungs may also cause chest pain. However, there may be no way for you to distinguish one type of chest pain from another. [winchesterhospital.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]
A syndrome typically consisting of angina (cardiac chest pain) at rest that occurs in cycles. [ebi.ac.uk]
She still experiences episodes of chest pain, but without syncope. [revportcardiol.org]
- Hypotension
The former can occur in any coronary artery at a distance of 1--4 cm from the catheter tip, is usually irregular and eccentric, and is associated with angina, ST segment elevation, hypotension, and dysrhythmia. [ajronline.org]
Abstract A woman with Prinzmetal's variant angina had spontaneous attacks of myocardial ischemia characterized by severe chest pain, hypotension, inferior ST-segment elevation, transient complete heart block and selective right ventricular dysfunction [cmaj.ca]
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]
Transient high-degree AVB is frequently associated with hypotension and syncope. 4 Although some of these arrhythmias can be fatal, the appropriate treatment for vasospastic angina in the absence of significant coronary stenosis is with nitrates and calcium [revportcardiol.org]
A repeat of his baseline vital signs revealed hypotension (80/50 mmHg), feeble radial pulse, and a blood sugar level of 112 mg/dL. [casereports.in]
Neurologic
- Confusion
The reason for this is the possible misdiagnosis or confusion with other conditions that might present with the same symptoms, and further evaluation is not sought. [statpearls.com]
On admission, the patient was pale and confused. SaO 2 90%, heart rate 62 b.p.m., blood pressure (BP) 70/40 mmHg, normal heart sounds with no additional murmurs, and his chest was clear on auscultation. There was no elevation of cardiac enzymes. [academic.oup.com]
- Aura
In the literature, migraine with aura but not the migraine without aura was associated with an increased risk of myocardial infarction and ischemic stroke. 2 The underlying pathophysiology of migraine is not fully understood. [revespcardiol.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]
Treatment
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]
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]
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]
Treatment / Management Treatment is focused on decreasing episodes of angina and preventing complications like myocardial injury and arrhythmia. Lifestyle modifications should be encouraged, especially smoking cessation. [statpearls.com]
Prognosis
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]
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]
[13] The prognosis of vasospastic angina depends on the extent of underlying coronary artery disease (CAD). [wikidoc.org]
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]
More common in young women, the etiology remains unclear. Symptoms usually occur at rest and are thought to be due to endothelial cell dysfunction. [healio.com]
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]
Epidemiology
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]
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]
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]
Pathophysiology
There are multiple precipitating factors that play a role in the pathophysiology of Prinzmetal’s angina. [eplabdigest.com]
Abstract Since the pathophysiologic mechanism inducing coronary artery spasm is poorly understood, both medical and surgical therapy remain empirical. [mdedge.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]
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
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]
Treatment with calcium channel blockers prevented recurrence of chest pain. [cardiocases.com]
The treatment is usually medical by drugs preventing smooth muscle contraction. [shl-telemedicine.com]