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.

Mentha longifolia alleviates experimentally induced angina via decreasing cardiac load

“…ECG changes are usually accompanying crises of coronary spasm in angina (Bayes de Luna et al, ). Initial ST segment elevation is the most famous change in ECG that indicates transmural ischemia (de Luna et al, ). The vasopressin injection in the current study was associated with a significant initial elevation in the ST segment height while M. longifolia pretreatment almost blocked this elevation.…”

Intracoronary Nitroglycerine Uncovering Coronary Spasm in Acute Coronary Syndrome; Should it be Part of the Routine?

“…Different ECG changes can appear during coronary artery spasm. The most important ECG change during a focal proximal coronary spasm in around 50% of cases is the appearance of peaked and symmetrical T waves that is followed, if the spasm persists, by progressive ST-segment elevation that last for a few minutes, and later progressively resolves [3]. When coronary angiography is normal and spasm is still suspected, the standard method for diagnosing CAS relies on coronary angiography and provocative tests.…”

2017 ISHNE-HRS expert consensus statement on ambulatory ECG and external cardiac monitoring/telemetry

“…Ambulatory ECG monitoring has also been utilized to diagnose and manage patients with the rare syndrome of Prinzmetal's variant angina, but confirmation of adequate therapeutic prevention of vasospasm episodes has been primarily based on provocative testing in the cardiac catheterization laboratory (Bayés de Luna et al, 2014;Waters, Szlachcic, Theroux, Dauwe, & Mizgala, 1981).…”