Article Text

  1. S. Stavrakis1,
  2. C. R. Vasamreddy1,
  3. P. Lozano1
  1. 1University of Oklahoma Health Sciences Center and VA Medical Center, Oklahoma City, OK.


Introduction Prinzmental's variant angina is a rare entity. It is characterized by transient ST-segment elevation, without evidence of myocardial necrosis. The pathogenesis of variant angina consists of coronary spasm associated with endothelial dysfunction. Cigarette smoking is the only established risk factor.

Case Report A 58-year-old Caucasian male with nonsignificant past medical history other than heavy smoking presented to the emergency department within an hour of the acute onset of typical chest pain. His initial ECG showed hyperacute T waves in leads II, III, and aVF. A few minutes later, a repeat ECG showed 2 mm ST-segment elevation in leads II, III, aVF, and RV4. Given his early presentation and the presence of inferior lead ST-segment elevation, it was decided to proceed with thrombolytic therapy. However, in the next few minutes, his pain resolved, together with the ST-segment elevation. Hence thrombolytic therapy was deferred. A subsequent coronary angiography revealed nonobstructive coronary artery disease. Cardiac enzymes were not elevated. The patient was discharged in a stable condition on calcium channel blockers and was strongly advised to quit smoking.

Conclusions In patients with acute myocardial infarction and ST-segment elevation, the earlier reperfusion therapy is provided, the greater the benefit. Since “time is myocardium,” it is important to make the diagnosis as quickly as possible. It is equally important, however, not to confuse other causes of ST-segment elevation, such as variant angina, with acute myocardial infarction, to prevent unwarranted thrombolytic therapy or emergency angiography.

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