title: Recurrent myocardial infarction secondary to Prinzmetal's variant angina.
abstract: Prinzmetal's variant angina describes chest pain secondary to reversible coronary artery vasospasm in the context of both diseased and non-diseased coronary arteries. Symptoms typically occur when the patient is at rest and are associated with transient ST-segment elevation. Acute episodes respond to glyceryl trinitrate, but myocardial infarction and other potentially fatal complications can occur, and long-term management can be challenging. Although it is not well understood, the underlying mechanism appears to involve a combination of endothelial damage and vasoactive mediators. In this case, a 35-year-old woman with myocardial infarction secondary to coronary artery vasospasm experienced recurrent chest pain. Coronary angiography revealed severe focal stenosis in the mid left anterior descending artery, which completely resolved after administration of intracoronary glyceryl trinitrate. The patient was discharged on nitrates and calcium channel blockers. The patient re-presented with another myocardial infarction, requiring up-titration of medical therapy.
authors.affiliation: Department of Cardiology, Gold Coast University Hospital, Southport, Queensland, Australia ; The University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Dale
authors.initials: D
authors.lastname: Murdoch
authors.affiliation: Department of Cardiology, Gold Coast University Hospital, Southport, Queensland, Australia.
authors.forename: Priyanka
authors.initials: P
authors.lastname: Dhillon
authors.affiliation: Department of Cardiology, Gold Coast University Hospital, Southport, Queensland, Australia ; Griffith University, School of Medicine, Gold Coast, Queensland, Australia.
authors.forename: Selvanayagam
authors.initials: S
authors.lastname: Niranjan
mesh_terms: D000328:Adult; D000788:Angina Pectoris, Variant / Q000150:complications* / Q000188:drug therapy; D003251:Constriction, Pathologic / Q000188:drug therapy / Q000473:pathology; D017023:Coronary Angiography; D003329:Coronary Vasospasm; D003331:Coronary Vessels / Q000503:physiopathology; D004562:Electrocardiography; D005260:Female; D006801:Humans; D009203:Myocardial Infarction / Q000150:complications* / Q000188:drug therapy / Q000473:pathology*; D005996:Nitroglycerin / Q000627:therapeutic use; D012008:Recurrence; D014665:Vasodilator Agents / Q000627:therapeutic use
chemical_list: D014665:Vasodilator Agents; D005996:Nitroglycerin
keywords: Prinzmetal’s variant angina; coronary artery spasm; myocardial infarction; vasospastic angina