Vasospastic (Prinzmetal) Angina Definition / Epidemiology: • Rest angina attributed to coronary artery vasospasm. • Patients often younger than other ACS patients. • Strong association with smoking and cocaine use. • Associated with other vasospastic disorders (Raynaud, migraine, etc.) Pathophysiology: • Diffuse spasm of epicardial coronary artery. • Vascular smooth muscle hyper-reactivity of coronary arteries. • Imbalance of vagal and sympathetic tone may precipitate spasm. • Associations with endothelial dysfunction and microvascular injury. Presentation: • Recurrent anginal chest pain • Episodes can be associated with ST segment changes. • Normal exercise tolerance • Pain is not positional • Variable troponin elevation Diagnosis: • Transient ST segment changes on tele/ECG that resolves with resolution of sx. • Can perform provocative tests in cath lab Treatment: • Smoking cessation • CCBs (prevent vasoconstriction, promote vasodilation • Nitrates? By @NUIM_Chiefs #Vasospastic #Prinzmetal #Angina #cardiology #diagnosis #management
