Prinzmetal

Prinzmetal, or Prinzmetal's angina, is a form of chest pain caused by transient coronary artery vasospasm that leads to brief episodes of myocardial ischemia. The condition is named after Myron Prinzmetal, who described it in 1959. It can occur with or without underlying atherosclerotic disease and often presents at rest, frequently at night or in the early morning.

Clinical features include sudden, intense chest pain that may be accompanied by sweating, palpitations, or faintness. During an episode, electrocardiography typically shows transient ST-segment elevation, which resolves as the pain recedes. Attacks usually last minutes to about 30 minutes and may occur in clusters or recur over days to weeks.

Pathophysiology involves hyperreactivity of the coronary smooth muscle and endothelial dysfunction, leading to vasospasm. Triggers include smoking, cocaine or amphetamine use, cold exposure, and certain medications. There is an association with other vasomotor disorders such as Raynaud phenomenon and migraines.

Diagnosis is based on history and documentation of transient ischemia during an attack. An electrocardiogram captured during pain often shows ST elevation. Coronary angiography between episodes may be normal; provocative testing with ergonovine or acetylcholine can induce spasm under controlled conditions to confirm the diagnosis.

Management focuses on preventing and relieving attacks. Acute episodes respond to sublingual or oral nitrates; long-term therapy commonly uses calcium channel blockers and nitrates. Smoking cessation is crucial; avoidance of vasoconstrictive drugs is recommended. Prognosis is generally favorable with treatment, but recurrent episodes and rare life-threatening arrhythmias can occur.