Abstract Body

Background: Prinzmetals Angina accounts for a greater number of patients presenting with chest pain to tertiary care health facilities requiring immediate management to reduce the incidence of complications such as heart attacks and strokes .This case explains the endothelial dysfunction as a rare cause of prinzmetal angina. She has a H/O patent foramen ovale,psoriatic arthritis,B/L optic nerve infarction with inferior field defect.Iron deficiency Anemia. Recurrent TIA

Introduction: 46 years old lady presented to A&E with complaint of increasing intensity chest pain and difficulty in breathing.

Case Description:On examination, patient was anxious with pain, blood pressure 148/88mmhg with a pulse rate 76 beats/min, slightly tachypneic with respiratory rate of 20/min. JVP-not raised. Rest of the examination was unremarkable. ECG showed TWI in leads III,V2 to V4.Initial investigations showed normal full blood count and kidney function, raised troponin level, urgent cardiology input was taken and coronary angiography was done which showed widespread and diffuse endothelial dysfunction resulting in coronary artery spasm and microvascular angina. Ultrasound angiology and nailfold capillaroscopy also showed vasospasm. Echo showed good LV function with EF 65-70%,normal structure and dimensions.

Outcome: The patient was started on IV GTN infusion(via porta cath) and her symptoms improved dramatically, remain stable during the hospital stay and discharged on CCB,isosorbide mono & dinitrate and advised for cardiology follow up in a few days time.