Unusual ECG Features of Prinzmetal Angina

To the Editor.— We encountered a case of angina of effort in which we found unusual ECG features. Report of a Case.— A 63-year-old woman was admitted to the hospital because of a two-day history of angina of effort that was unrelieved by treatment with nitrites. She gave a history of hypertension and diabetes for the last 20 years and of angina of effort for the last two years. Results of physical examination on admission (April 15) were unremarkable, except for an atrial sound audible at the apex. Her blood pressure was 140/80 mm Hg, and her pulse rate was 80 beats per minute. There was borderline cardiomegaly on chest roentgenogram. An ECG showed nonspecific ST-T wave changes (identical to A in the Figure). Fifteen minutes after a renal arteriogram (May 7) was performed, the patient had severe retrosternal chest pain associated with hypotension and bradycardia. Serial ECGs are depicted