Abstract
Prinzmetal's angina is a vascular spasm of the coronary artery that can mimic acute coronary syndrome. It is rarely responsible for ventricular arrhythmias and cardiac arrest; however, survivors with these complications are at increased risk for recurrent ventricular arrhythmias and sudden cardiac death. This is true despite the presence of normal cardiac function and optimal medical therapy. Thus, this select population should be considered for an implantable cardioverter defibrillator (ICD). In this case vignette, we describe a healthy 48-year-old female with ventricular fibrillation arrest, followed by recurrent ventricular tachyarrhythmias caused by Prinzmetal's angina.
Highlights
Vasospastic angina (VSA), variant angina (VA), or Prinzmetal’s angina is a focal spasm of one or more coronary arteries, without clinically significant atherosclerosis or atherosclerotic plaque
VSA is a widespread diagnosis that includes documented spontaneous attacks of angina pectoris elicited by coronary epicardial vasospasm (EV) and/or coronary microvascular dysfunction (CMD)
The significance of diagnosing VSA is tied to the major complications correlated with this disorder, including acute myocardial infarction, arrhythmias, or sudden cardiac death (SCD) [9,10,11], and, in turn, the potential to prevent these life-threatening events by using nitrates and calcium channel blockers and by avoiding potential vasospasm stimuli (2)
Summary
Vasospastic angina (VSA), variant angina (VA), or Prinzmetal’s angina is a focal spasm of one or more coronary arteries, without clinically significant atherosclerosis or atherosclerotic plaque. These spasms are responsible for inducing anginal symptoms and temporary ischemia [1, 2]. Despite optimal medical treatment with calcium channel blockers and nitrates, 5% to 30% of patients continue to have recurrent anginal episodes. Both myocardial infarction and arrhythmia resulting in sudden cardiac death may occur [5]. While vasodilator therapy provides relief of anginal symptoms and ventricular arrhythmia episodes, implantable cardioverter defibrillator (ICD) implantation is the treatment of choice in the case of recurrence, combined with medical therapy [6]
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