Pathology of Angina Pectoris: Prinzmetal angina,Variant angina :USMLE Step 1 coronary artery disease 

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Pathology of Angina Pectoris: Prinzmetal angina,Variant angina) USMLE Step 1 coronary artery disease
Vasospastic angina (Prinzmetal angina, Variant angina)
• A condition characterized by episodic chest pain caused by coronary artery spasm. Symptoms can occur at rest. Triggers include smoking, stimulants (e.g., cocaine), triptans, alcohol, and stress. Associated with reversible ST elevations on ECG. Does not cause an increase in serum concentrations of cardiac biomarkers.
Description :
• Angina caused by transient coronary spasms (usually occurring close to areas of coronary stenosis)
• Unrelated to exertion and may even occur at rest (classically at night)
Etiology : e.g., cigarette smoking, use of stimulants (e.g., cocaine, amphetamines) or sumatriptan, alcohol, stress, hyperventilation, exposure to cold
• There is an association with other disorders involving vasospasms (e.g., Raynaud phenomenon, migraine headaches)
Epidemiology : average onset around 50 years
Diagnostics :
• Reversible ST elevation on ECG
• No troponin I or T level elevations on serial measurements
• Coronary spasms on angiography confirm the diagnosis
Treatment :
• Risk factor modification
• Calcium channel blockers and nitrates: first-line agent for acute attacks and prophylaxis
• Avoid beta-blockers!
Prognosis :
• The five-year survival rate is greater than 90% (with treatment).
• Persistence of symptoms is common.
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