Skip to main content
SpringerLink
Log in

Transient electrocardiographic recording of acute myocardial ischemia with ST-segment elevation of the diaphragmal location accompanied by a total atrioventricular block as an initial manifestation of Prinzmetal’s angina — A case report

  • Case Report
  • Published:
Central European Journal of Medicine

Abstract

Prinzmetal’s angina, also known as Prinzmetal’s variant or Prinzmetal’s vasospastic angina is characterized by angina attacks caused by spasm of the great epicardial coronary arteries. Coronary artery endothelial dysfunction plays a crucial role in the development of this vasospastic angina. The attacks of vasospastic angina can be prevented with calcium antagonists and nitrates, whereas in refractory variant angina, coronary angioplasty with stenting may help prevent further coronary spasm. In this case report, we present a 52-year-old male patient with a transient electrocardiographic recording of acute myocardial ischemia with ST-segment elevation of the diaphragmal location accompanied by a total atrioventricular block immediately after exercise testing and as a first manifestation of Prinzmetal’s angina. After regression of the symptoms and electrocardiographic changes, significant pathomorphologic changes of coronary arteries were excluded by coronary angiography. Following discharge, the patient was treated with calcium antagonists and did not show symptoms during a 4-year follow-up period.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. E.J. Topol: Textbook of cardiovascular medicine, New York — Philadelphia, Lippincott Raven, 1998, pp. 345–60.

    Google Scholar 

  2. J.J. Li, J.M. Chu and C.Y. Zhang: “Variant angina in a 17-year old male”, Acta Cardiol., Vol. 60, (2005), pp. 69–71.

    Article  PubMed  Google Scholar 

  3. M.E. Bertrand, M.L. Simoons, K.A. Fox, L.C. Wallentin, C.W. Hamm, E. de McFadden, P.J. Feyter, G. Specchia and W. Ruzyllo: “Management of acute coronary syndromes: acute coronary syndromes without persistent ST segment elevation; recommendations of the Task Force of the European Society of Cardiology”, Eur. Heart. J., Vol. 21, (2001), pp. 1406–1432.

    Article  Google Scholar 

  4. S.B. Chaitman: “Exercise stress testing”, In: E. Braunwald: Heart disease, Elsevier Saunders, 2005, pp. 153–185.

  5. T. von Arnim, H.W. Gerbig and A. Erath: “Arrhythmias in relation to transient ST elevation in Prinzmetal angina: induction by occlusion and reperfusion”, Z. Kardiol., Vol. 74, (1985), pp. 585–589.

    Google Scholar 

  6. Y. Miyao, K. Kugiyama, H. Kawano, T. Motoyama, H. Ogawa, M. Yoshimura, T. Sakamoto and H. Yasue: “Diffuse intimal thickening of coronary arteries in patients with coronary spastic angina”, J. Am. Coll. Cardiol., Vol. 36, (2000), pp. 432–437.

    Article  PubMed  CAS  Google Scholar 

  7. S. Takagi, Y. Goto, E. Hirose, M. Terashima, S. Sakuragi, S. Suzuki, Y. Tsutsumi, S. Miyazaki and H. Nonogi: “The preventive treatment of refractory vasospastic angina with corticosteroids: coronary arterial hyperactivity caused by local inflammation”, Circ. J., Vol. 68, (2004), p. 806.

    Article  Google Scholar 

  8. M.J. Hung, W.J. Cherng, C.W. Cheng and N.I. Yang: “Effect of antispastic agents (calcium antagonists and/or isosorbide dinitrate) on high-sensitivity C-reactive protein in patients with coronary vasospastic angina pectoris and no hemodynamically significant coronary artery disease”, Am. J. Cardiol., Vol. 95, (2005), pp. 84–87.

    Article  PubMed  CAS  Google Scholar 

  9. H. Teragawa, M. Kato, T. Yamagata, H. Matsuura and G. Kajiyama: “The preventive effect of magnesium on coronary spasm in patients with vasospastic angina”, Chest., Vol. 118, (2000), pp. 1690–1695.

    Article  PubMed  CAS  Google Scholar 

  10. T. Motoyama, H. Kawano, K. Kugiyama, O. Hirashima, M. Ohgushi, R. Tsunoda, Y. Moriyama, Y. Miyao, M. Yoshimura, H. Ogawa and H. Yasue: “Vitamin E administration improves impairment of endothelium-dependent vasodilatation in patients with coronary spastic angina”, J. Am. Coll. Cardiol., Vol. 32, (1998), pp. 1672–1679.

    Article  PubMed  CAS  Google Scholar 

  11. M. Meader, P. Ammann, W. Angehrn and H. Rickli: “A case of coronary vasospasm treated with stent placement”, Z. Kardiol., Vol. 92, (2003), pp. 182–187.

    Article  Google Scholar 

  12. G.A. Rodriguez-Granillo, E.P. McFadden, M. Valgimigli, C.A. van Mieghem, E. Regar, P.J. de Feyter and P.W. Serruys: “Coronary plaque composition of non culprit lesions, assessed by in vivo intracoronary ultrasound radio frequency data analysis, is related to clinical presentation”, Am. Heart J., Vol. 151, (2006), pp. 1020–1024.

    Article  PubMed  Google Scholar 

  13. K. Sano, M. Kawasaki, M. Okubo, H. Yokohama, Y. Ito, I. Murata, T. Kawai, K. Tsuchiya, K. Nishigaki, G. Takemura, S. Minatoguchi, X. Zhou, H. Fujita and H. Fujiwara: “In vivo quantitative tissue characterization of angiographically normal coronary lesions and the relations with risk factor: a study using integrated backscatter intravascular ultrasound”, Circ. J., Vol. 69, (2005), pp. 543–549.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Cardiology, Hospital for Medical Rehabilitation, Krapinske Toplice, Croatia

    Krunoslav Fuckar & Nenad Lakusic

  2. Department of Cardiology, Special Hospital for Cardiology And Cardiovascular Surgery “Magdalena”, Krapinske Toplice, Croatia

    Hrvoje Stipic

Authors
  1. Krunoslav Fuckar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nenad Lakusic
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hrvoje Stipic
    View author publications

    You can also search for this author in PubMed Google Scholar

About this article

Cite this article

Fuckar, K., Lakusic, N. & Stipic, H. Transient electrocardiographic recording of acute myocardial ischemia with ST-segment elevation of the diaphragmal location accompanied by a total atrioventricular block as an initial manifestation of Prinzmetal’s angina — A case report. cent.eur.j.med 2, 108–115 (2007). https://doi.org/10.2478/s11536-007-0003-9

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.2478/s11536-007-0003-9

Keywords

Search

Navigation