[Variant (Prinzmetal's) angina with diffuse coronary spasm without coronary sclerosis].
A 49-year-old man developed, over a period of three years, progressively more frequent nocturnal attacks of angina and palpitations. Exercise electrocardiogram was negative. 24-hour Holter monitoring revealed ventricular extrasystoles and tachycardia with ST segment elevations. The dominant left coronary artery, which was free of atherotic changes, went into diffuse spasm after ergonovine administration, accompanied by angina and ventricular extrasystoles. Registration of spontaneous ischaemia confirmed the diagnosis of variant (Prinzmetal) angina. Administration of twice daily 90 mg diltiazem retard and once daily 120 mg isosorbide dinitrate retard at night ended the spasms and with it the attacks of angina and the arrhythmias. This case illustrates that typical angina and ventricular tachyarrhythmias can be caused by spontaneous coronary spasms, even in the presence of normal exercise ECGs and coronary angiograms. If coronary artery spasms are not detectable by ECG, the ergonovine test may further the diagnosis.
III. Medizinische Klinik--Kardiologie, Klinikum Rudolf Virchow (Standort Wedding), Freie Universität Berlin.
A
A
Willberg
G
G
Lieb
D
D
Nunberger
H
H
Hochrein
D000788:Angina Pectoris, Variant / Q000175:diagnosis* / Q000188:drug therapy; D006328:Cardiac Catheterization; D003324:Coronary Artery Disease / Q000175:diagnosis*; D003329:Coronary Vasospasm / Q000175:diagnosis* / Q000188:drug therapy; D003692:Delayed-Action Preparations; D004110:Diltiazem / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D004452:Echocardiography; D004562:Electrocardiography; D006801:Humans; D007548:Isosorbide Dinitrate / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged
D003692:Delayed-Action Preparations; D004110:Diltiazem; D007548:Isosorbide Dinitrate
Variant(Prinzmetal)-Angina mit diffusem Koronarspasmus ohne Koronarsklerose.