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(Circulation. 1973;47:476.)
© 1973 American Heart Association, Inc.

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Variant Angina of Prinzmetal with Normal Coronary Arteriograms

A Variant of the Variant

TSUNG O. CHENG M.D.¹; TALI BASHOUR M.D.¹; GEORGE A. KELSER JR. M.D.¹; LOWELL WEISS M.D.¹; JAMES BACOS M.D.¹

¹ From the Division of Cardiology, Department of Medicine, The George Washington University Medical Center, District of Columbia General Hospital and Washington Hospital Center, Washington, D. C.

Variant angina of Prinzmetal has been generally presumed to be caused by a significant focal obstruction in a single major coronary artery which should be an ideal lesion for aortocoronary saphenous vein bypass graft. Recognition of this clinical syndrome would then be of particular diagnostic and therapeutic importance if such a consistent association can be demonstrated. Of five patients with variant angina studied in our cardiac catheterization laboratories, four had normal coronary arteriograms. Two important conclusions may be derived from this study. First, identical ECG changes may be observed both in the presence and absence of pain and thus the incidence and severity of the variant angina could be underestimated. Second, until a larger series of patients with variant angina is studied by coronary arteriography, one must exercise reservation in assuming that all patients with the clinical syndrome are operative candidates for saphenous vein bypass surgery.

Key Words: Aortocoronary saphenous vein bypass • Exercise electrocardiogram • Oxygen-hemoglobin dissociation • Atrial pacing • Papillary muscle dysfunction • Coronary artery spasm

Submitted on July 18, 1972
Accepted on November 12, 1972

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