Variant Angina

Spasm is  or healthy vessels.

Angina chest pain

   One quarter have vasospastic symptoms like migraine and Raynaud’s phenomenon.

History

     Rest pain, often same time each day.

     May have classic angina pain as well.

     Often no exertional symptoms.

Diagnosis

Angina

Angina

    ST elevation during pain most diagnostic.

    Transient arrhythmia and conduction disturbances.

    Occasionally transient Q waves.

    Transient wall motion abnormality in ECHO.

    Alternate cycles of activity.

Treatment

        Calcium channel blockers most effective, particularly nifedipine. Prazosin, an alfa blocker may be effective.

        Nitrates and betablockers may be detrimental.

Myocardial hibernation and stunning

Areas of myocardium which is under perfused but viable may show contractile dysfunction as an adaptive response (hibernation). It can be diagnosed in PET radionuclide testing and dobutamine stimulation. This dysfunction is fully reversible following revascularization. Myocardial stunning is the occurrence of persistent contractile dysfunction following prolonged or repetitive ischemia.

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