The Variant Form of Angina Pectoris; Sequence of ST-T Alterations

Abstract

tion of ST segment, Prinzmetal delineated as the variant form of angina pectoris and offered explanation of its distinct clinical signs pointing to the severe ischemia. This new syndrome is contrasted with the classic form of angina pectoris caused by mild ischemia and manifesting itself in the electrocardiogram as ST depression. These two degrees of ischemia are related to two different patterns of cell metabolism and with different ionic currents across the membrane. Few clinical descriptions are available. In the reported case the attacks of variant form of angina pectoris recurring for two months has heralded the formation of myocardial infarction. A 54-year-old geologist was admitted to the hospital on August 20, 1965 due to frequent pressing pains in the middle of the chest, radiating to both shoulders. Anginal pains had occurred for the last three years after effort. Two years earlier significant S-T depression was recorded after exercise test. In the last weeks, anginal pains became more frequent and for ten days occurred at rest and during the night. For two years, he had been receiving anticoagulant treatment. On admission, the action of the heart was regular, blood pressure 150/70 mm Hg; electrocardiogram was normal, ESR was 22 mm after one hour and 35 mm after two hours, leukocyte count was 5,300, SGOT: 34 units, SGPT: 24 units. The diagnosis of imminent infarction was made and he was treated with bed rest, sedation and long acting coronary vasodilators.