Prinzmetal angina or variant angina, was first described in 1959. This is a rare form of angina associated with coronary artery spasm - the vessels that supply blood to the heart; This distinguishes it from other types of diseases in which the blood supply to the heart is disturbed, generally because of reduction of the lumen of the arteries as a result of atherosclerosis. In some cases, Prinzmetal variant angina can lead to serious ventricular arrhythmia, myocardial infarction and sudden death.
According to statistics, Prinzmetal angina occurs, on average, four cases per 100 000, but the prevalence of this disorder in the different countries are not the same. For example, in Britain, people rarely suffer from spasms of the coronary arteries - researchers attribute this to the fact that there are widely used calcium channel blockers, which are prescribed for the treatment of various diseases (these drugs relax the walls of blood vessels). In Japan and South Korea, spasms of the coronary arteries are detected in 40% of patients who go to the doctor complaining of symptoms associated with angina, and which pass angiography.
It is not known exactly what causes a spasm of the coronary arteries. They can develop in people who do not suffer from coronary heart disease associated with impaired patency of the arteries that feed the heart muscle. However, some patients with angina and Prinzmetal detected severe coronary artery disease affecting at least one of the coronary arteries. In such cases, spasm normally occurs in the area where the blood vessel patency broken.
It is assumed that triggers spasms in the coronary arteries Prinzmetal angina can become a strong emotional stress, exposure to very low temperatures, the use of cocaine, smoking, drugs which can narrow blood vessels.
Symptoms of angina Prinzmetal
During an attack of angina pectoris
Angina - oxygen deficiency
Prinzmetal patients usually feel a pressure, a very strong pain in the retrosternal space - sometimes referred section, located behind the breastbone. The pain often radiates to the neck, jaw, shoulders and arms. Generally, variant angina attacks occur at rest; they may start each time at one and the same time, and often it occurs between midnight and eight o'clock in the morning. An attack can last anywhere from five minutes to half an hour. Chest pain quickly goes away after taking nitroglycerin. Sometimes angina leads to heart palpitations and loss of consciousness. In some cases, during an attack and / or slightly after Prinzmetal angina attack patients experience severe headache intensity close to pain that occur in migraine.
Diagnosis of angina Prinzmetal
In the diagnosis of angina can be used Printsemetala electrocardiography at rest; its results are particularly useful during attacks of this disorder. Stress test ECG usually gives a negative result, because patients with variant angina
Variant angina - severe and under-studied form
symptoms not associated with physical activity.
Coronary angiography is useful in cases where Prinzmetal angina is associated with impaired patency of the arteries.
Furthermore, for the diagnosis of variant angina apply so-called provocative tests. Initially, during their conduct of the work of the heart was observed only with the help of an electrocardiogram. However, after several patients died during the procedure, provocation tests carried out in the steel during coronary angiography: This method allows the rapid detection artery spasms and, if necessary, to eliminate them with drugs.
Provocative test is that physicians cause the patient to coronary artery spasm, using various means, e.g., methacholine, adrenaline, phenylephrine, serotonin, histamine, dopamine. However, currently this purpose are most often used acetylcholine and ergonovine.
In the differential diagnosis is necessary to exclude violations such as myocardial infarction and acute coronary syndrome.
Treatment of angina Prinzmetal
For successful treatment of variant angina is important to avoid the factors that can provoke repeated bouts of illness. These factors include smoking, alcohol consumption, severe stress
How to beat stress? Create an oasis
Anxiety - how to distinguish normal from disease?
If angina Prinzmetal happened the first time, the patient required hospitalization; in the hospital his condition will be closely watched doctors and will be carried out a detailed examination.
To relieve the symptoms of an attack are advised to take from one to three nitroglycerin tablets. To prevent further attacks, may be used the following formulations:
- Calcium channel blockers - these drugs in most cases effectively prevent spasms of the coronary arteries are typical variant angina;
- Beta-blockers in combination with nitrates and / or calcium channel blockers may be administered to patients with severe coronary artery disease.
In cases where drug therapy fails, surgical intervention is necessary.
Prinzmetal angina can lead to the following complications:
- Myocardial infarction. The probability of this complication is 30%, and is highest in patients with severe coronary artery disease;
In rare cases, variant angina can result in sudden death of the patient. The risk of death is particularly high if the disease is accompanied by a few spasms of the arteries.
The forecast is favorable, provided that patients taking calcium channel blockers, refrain from smoking and, in general, lead a healthy lifestyle.