Further Variant Patterns within Prinzmetal Angina Pectoris

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. Asingle 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.