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(Circulation. 2000;101:e107.)
© 2000 American Heart Association, Inc.

Circulation Electronic Pages

Prinzmetal’s Angina

Etienne Delacretaz, MD; James M. Kirshenbaum, MD; Peter L. Friedman, MD, PhD

From the Department of Medicine, Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass.

Correspondence to Peter L. Friedman, MD, PhD, Cape Cod Cardiovascular Associates, 14 Yellow Brick Rd, Hyannis, MA 02601.

	Introduction

 
A67-year-old woman with a history of arterial hypertension, peripheral vascular disease, and chronic atrial fibrillation presented with atypical chest pain for 1 year. The episodes occurred at rest and lasted 5 to 30 minutes, occasionally waking her from sleep. During the week before her admission, she developed recurrent short episodes of lightheadedness associated with the episodes of chest pain. She was referred to an outside hospital to undergo a stress test with nuclear imaging. The day of the test, she had several episodes of chest pain and 2 episodes of lightheadedness. However, she drove to the hospital. She was again feeling chest pain at the time she entered the testing room. While lying down awaiting the arrival of a physician, she had a cardiac arrest. She received cardiopulmonary resuscitation; ventricular fibrillation was present on the external defibrillator monitor <1 minute after the loss of consciousness. A 300-J shock restored sinus rhythm. The 12-lead ECG immediately after ventricular defibrillation (Figure 1A) shows rapid atrial fibrillation, absence of R-wave progression from V₁ to V₃, and ST-segment elevation in anterolateral and inferior leads. ST-segment elevation persisted in leads V₁ through V₃ 5 minutes later (B) but completely resolved 2 hours after the event (C). There was no elevation of creatine kinase or troponin I. Cardiac catheterization performed the same day revealed irregularities of the middle portion of the left anterior descending coronary artery (LAD) without significant stenosis, as well as normal left ventricular size and function. The patient was then referred . . . [Full Text of this Article]

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