Girl Who Cried Wolf: A Case of Prinzmetal Angina With Related ST-Elevation Myocardial Infarction

Abstract

Prinzmetal variant angina is characterized by episodic chest pain associated with transient ST changes seen on an electrocardiogram (EKG). A 51-year-old female with a pertinent history of non-obstructive coronary artery disease (CAD), non-ST elevation myocardial infarction (NSTEMI) twice, ST-elevation myocardial infarction (STEMI), Prinzmetal angina, ventricular tachycardia s/p implantable cardioverter-defibrillator placement, and gastroesophageal reflux disease presented with 2.5 hours of left-sided chest pain with radiation to the left arm. Her initial EKG was not revealing. However, a subsequent EKG showed ST elevations in the inferior leads. A coronary angiogram was performed and revealed distal right coronary artery spasm that was relieved with intracoronary nitroglycerin. The nature of her chest pain in conjunction with her EKG and angiogram findings helped diagnose her with Prinzmetal angina that was significant enough to result in a STEMI. Thus, Prinzmetal angina and STEMI can be interconnected rather than being separate, mutually exclusive pathologies.

Vasospasm-induced ST-segment elevation myocardial infarction in a premenopausal woman with endothelial dysfunction

“…Coronary artery vasospasm (VSA) can cause anterior ST-segment elevation myocardial infarction (STEMI) which is relatively infrequent manifestation of myocardial infarction with nonobstractive coronary artery (MINOCA; [ 1 , 2 ]). VSA has been reported to be more common in male smokers with significant coronary risk factors who are over the age of 50–60.…”