title: Prinzmetal angina: ECG changes and clinical considerations: a consensus paper.
abstract: BACKGROUND
  We will focus our attention in this article in the ECG changes of classical Prinzmetal angina that occur during occlusive proximal coronary spasm usually in patients with normal or noncritical coronary stenosis.
  
  
  RESULTS
  The most important ECG change during a focal proximal coronary spasm is in around 50% of cases the appearance of peaked and symmetrical T wave that is followed, if the spasm persist, by progressive ST-segment elevation that last for a few minutes, and later progressively resolve. The most frequent ECG changes associated with ST-segment elevation are: (a) increased height of the R wave, (b) coincident S-wave diminution, (c) upsloping TQ in many cases, and (d) alternans of the elevated ST-segment and negative T wave deepness in 20% of cases. The presence of arrhythmias is very frequent during Prinzmetal angina crises, especially ventricular arrhythmias. The prevalence and importance of ventricular arrhythmias were related to: (a) duration of episodes, (b) degree of ST-segment elevation, (c) presence of ST-T wave alternans, and (d) the presence of >25% increase of the R wave.
  
  
  CONCLUSIONS
  The incidence of Prinzmetal angina is much lower then 50 years ago for many reasons including treatment with calcium channel blocks to treat hypertension and ischemia heart disease and the decrease of smoking habits.
authors.affiliation: Santa Creu i Sant Pau Hospital, Cardiovascular Research Center, CSIC-ICCC, Barcelona, Spain.
authors.forename: Antonio Bayés
authors.initials: AB
authors.lastname: de Luna
authors.forename: Iwona
authors.initials: I
authors.lastname: Cygankiewicz
authors.forename: Adrian
authors.initials: A
authors.lastname: Baranchuk
authors.forename: Miquel
authors.initials: M
authors.lastname: Fiol
authors.forename: Yochai
authors.initials: Y
authors.lastname: Birnbaum
authors.forename: Kjell
authors.initials: K
authors.lastname: Nikus
authors.forename: Diego
authors.initials: D
authors.lastname: Goldwasser
authors.forename: Javier
authors.initials: J
authors.lastname: Garcia-Niebla
authors.forename: Samuel
authors.initials: S
authors.lastname: Sclarovsky
authors.forename: Hein
authors.initials: H
authors.lastname: Wellens
authors.forename: Günter
authors.initials: G
authors.lastname: Breithardt
mesh_terms: D000788:Angina Pectoris, Variant / Q000503:physiopathology*; D023921:Coronary Stenosis / Q000503:physiopathology*; D003329:Coronary Vasospasm / Q000503:physiopathology*; D004562:Electrocardiography; D006801:Humans; D017180:Tachycardia, Ventricular / Q000503:physiopathology*
keywords: Prinzmethal angina; ST elevation; coronary spasm; electrocardiography