Coronary Arterial Spasm in Prinzmetal Angina

A woman with Prinzmetal angina displayed spontaneous attacks of myocardial ischemia characterized by severe chest pain, hypotension, inferior-wall ST-segment elevation and transient complete heart block. Coronary arteriography during several fully developed spontaneously occurring attacks demonstrated spasm of a right coronary artery that appeared to be anatomically normal. The site, extent and degree of obstruction varied during individual attacks. Immediately after an attack subsided the coronary artery appeared normal. These observations suggest that coronary arteriography should be attempted, if possible, during clinical attacks of pain in patients with Prinzmetal angina. Even those who have a focal atherosclerotic obstruction may have additional distal coronary arterial spasm. Spasm beyond a proximal obstruction may preclude the use of saphenous-vein bypass therapy alone. Coronary arterial vasodilators may be an important additional therapeutic measure.