Angina Pectoris at Rest with Preservation of Exercise Capacity

Twenty patients with Prinzmetal's variant of angina are described and the literature on the subject is reviewed. This syndrome is characterized by anginal attacks at rest with S-T segment elevation, while exercise capacity is well preserved. Coronary arteriography usually demonstrates significant, focal, obstuctive disease of the major coronary artery predicted from the distribution of S-T elevation seen in the ECG during attacks. Occasionally the coronary disease is minimal or absent. The cause of attacks is believed to be transient, spastic occlusion of a major coronary artery, which was actually observed during surgery in one case. Because of this unusual pathophysiology, these patients may not make ideal candidates for isolated saphenous vein bypass surgery. Other diagnostic, therapeutic, and prognostic implications of this interesting anginal syndrome are discussed.