Current concepts of Prinzmetal’s variant form of angina pectoris
Variant angina is a clinical-electrocardiographic syndrome first described by Prinzmetal et al1 in 1959. Although others had described similar cases previously,2–7 Prinzmetal was the first to suggest that the clinical picture in these patients formed a discrete entity.
The essential characteristics of this syndrome are (1) recurrent attacks of angina unrelated to exertion which usually occur at rest or with normal activity, (2) concomitant S-T segment elevation in EKG leads reflecting the area of myocardial ischemia, and (3) return of the electrocardiogram to its previous appearance following attacks (Table 1).
The pattern of chest pain is variable: it may follow an intermittent or stable course for months to years, it may present as accelerated angina over a short period, or it may appear only in the immediate preinfarction or postinfarction period.8 The first two patterns are the ones we usually associate with the term Prinzmetal’s variant angina. Perhaps the third group should be classified separately as peri-infarction Prinzmetal’s angina.
The episode of angina usually lasts less than 15 minutes, but may be prolonged. It often occurs at rest, with a predictable daily pattern. The interval between pains may be minutes to years. In patients with long periods between attacks, diagnosis may be difficult due to the logistical problem of obtaining an electrocardiogram during attacks.
In addition to rest pain, typical exertional angina occurs in nearly 50% of patients, but it is usually a minor part of the clinical picture.1, 8–10 Stress tests are also positive in nearly 50%...