Further Variant Patterns within Prinzmetal Angina Pectoris

¹ Physician-in-Charge, Coronary Care Unit, The Brookdale Hospital Medical Center; Assistant Professor, Clinical Medicine, New York University, School of Medicine
² Section of Cardiology, Department of Medicine, The Brookdale Hospital Medical Center and State University of New York, Downstate Medical Center, Brooklyn
³ Associate Professor, Department of Medicine, State University of New York, Downstate Medical Center
⁴ Director of Medicine and Cardiology, The Brookdale Hospital Medical Center; Professor of Clinical Medicine, New York University, School of Medicine

A diagnosis of Prinzmetal variant angina was made in 12 patients admitted to a coronary care unit. Five patients without a history of myocardial infarction were observed to have episodic ST segment elevation in electrocardiographic leads corresponding to the distribution of a major coronary artery in the absence of chest pain. Seven others, five patients with acute myocardial infarction, and two patients with remote transmural infarction, demonstrated typical clinical and electrocardiographic findings of the Prinzmetal variant in the period after infarction. A single focal obstructive lesion was angiographically demonstrated in only two of six patients studied. Four patients demonstrated focal and diffuse disease involving two or more coronary arteries. The clinical spectrum of Prinzmetal angina must now be extended to include both painless and post infarction variants. Diffuse, widespread coronary involvement as well as "spasm" in apparently normal coronary vessels, or single vessel, focal obstructive disease may be demonstrable angiographically.