(Circulation. 2001;103:2766.)
© 2001 American Heart Association, Inc.
Images in Cardiovascular Medicine |
Prinzmetal Angina Documented by Transtelephonic Electrocardiographic Monitoring
From the Department of Cardiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
Correspondence to Renke Maas, MD, Dept of Cardiology, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany. E-mail maas{at}uke.uni-hamburg.de
A60-year-old man
suffered from paroxysmal episodes of palpitations, angina, and
shortness of breath lasting 5 to 10 minutes. The episodes occurred
about twice a month and were not related to physical activity or
stress. Resting-, exercise- and Holter-ECG and the clinical examination
revealed no abnormalities. A coronary angiogram showed only
mild coronary artery disease, with no significant
stenosis
(Figure
,
a). To elucidate the cause of the episodes, the patient received a
credit card–sized event ECG recorder
(Rhythmcard) that was capable of
recording and transmitting 1-minute single-lead ECGs. He was
instructed to record and transmit an ECG in case of symptoms and to
record an additional ECG immediately after each
symptomatic episode. The patient’s reference ECG was
recorded at rest while he was asymptomatic
(Figure,
b). After 1 week, while having typical symptoms again, the patient
recorded an ECG
(Figure,
c) with marked ST elevations. In the ECG
(Figure,
d) recorded 5 minutes after the symptoms terminated, the ST segment
was almost normalized.
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These findings were highly suggestive of Prinzmetal angina, and the patient was treated with retarded nifedipine 20 mg BID and retarded diltiazem 90 mg BID. During a follow-up of 4 months, the patient was free of symptoms. This case demonstrates that single-lead event ECGs can be of diagnostic value in the work-up of paroxysmal chest pain.
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