Abstract Body

Introduction: Vasospastic or Prinzmetal angina is characterized by episodes of rest angina associated with transitory ST segment elevation on ECG, that are caused by a focal or diffuse epicardial coronary artery spasm. Smoking is a major risk factor; other possible triggers are alcohol and drug consumption. The prognosis depends on the presence and extent of fixed atherosclerotic lesions. Patients with vasospastic angina and normal coronary arteries have in most cases good prognosis. The authors present one case of Vasospastic angina.

Case Report: A 54-year-old man smoking 20 cigarettes, with moderate alcohol consumption and dyslipidemia, reported recurrent episodes of syncope and mild chest pain at rest which spontaneously ceased after a few minutes. Of the diagnostic tests performed, ECG was normal, echocardiogram also normal, with good ventricular systolic function and cardiac stress test without symptoms and any ST-T alterations. Holter showed 5-minute duration periods of supra ST at night, without symptoms, compatible with Prinzmetal Angina. The patient was medicated with a calcium channel antagonist and a nitrate and underwent cardiac catheterization, which showed angiographically normal coronary arteries. He remained asymptomatic since then.

Conclusion: Vasospastic angina remains highly challenging to diagnose, but has important symptomatic and prognostic implications. Management includes cessation of smoking and pharmacologic therapy. When not associated with heart disease, long-term prognosis is good, particularly those receiving medical therapy, thus coronary vasospasm does not by itself result in a significant increase in mortality, although patients who present with syncope may be at greater risk.