RESUMO
Eight patients with typical Prinzmetal's angina and angiography proven coronary artery spasm are reviewed. In all cases the angina pain appeared at rest and was accompanied by a simultaneous ST-segment elevation. The coronary angiography results varied from severe multivessel disease (3 cases) to single vessel disease (3 cases), and normal coronary arteries (2 cases). In all patients a coronary spasm was documented, in five cases induced by ergonovine and in three spontaneously; in all patients but in one, the localization of the spasm was concordant with the ST-segment elevation localization. One case with a severe proximal left anterior descending stenosis was grafted; however the pain was not relieved despite treatment with large amounts of propranolol. This patient died after an episode of severe chest pain. Treatment with nifedipine was given to six patients, with excellent results in four cases, and regular response in two. The main physiopathologic diagnostic and therapeutic aspects of the variant angina syndrome are reviewed.
Assuntos
Angina Pectoris Variante/diagnóstico , Vasoespasmo Coronário/diagnóstico , Idoso , Angina Pectoris Variante/complicações , Angina Pectoris Variante/tratamento farmacológico , Vasoespasmo Coronário/tratamento farmacológico , Vasoespasmo Coronário/cirurgia , Eletrocardiografia , Bloqueio Cardíaco/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Nifedipino/uso terapêutico , Propranolol/uso terapêuticoRESUMO
Presentamos 8 pacientes, todos varones y con edades entre 48 y 65 anos, con un sindrome de dolor precordial tipico de angina variante.En todos ellos pudo demostrarse coronariograficamente un espasmo coronario, siendo en tres espontaneo y en cinco provocado mediante metilergonovina intravenosa. En todos los casos, menos uno, la localizacion del espasmo fue concordante con la de la elevacion del espacio ST durante el dolor. En cinco de los pacientes la nifedipina controlo completamente la crisis a largo plazo, y uno de ellos, que no la tomaba, fallecio en el curso de un episodio de angina severa, a pesar de haber sido intervenido previamente de pontaje aorto-coronario a la descendente anterior con exito. En base a estos hallazgos, revisamos los conocimientos actuales sobre la angina variante, especialmente en sus aspectos fisiopatologico, diagnostico y terapeutico