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Prinzmetal's Angina


Step 1: View clinicals

A 50 year old man was woken up 1 hour ago by sudden onset, severe retrosternal chest pain radiating to the jaw, neck, and left arm. He went to see his primary care practitioner, who obtained an ECG and said that he was having a 'heart attack'. He was then administered Aspirin and sublingual Nitroglycerin and rushed to hospital. Now, at presentation, his chest pain has subsided completely. His medical history is unremarkable, while a full blood count and chest x-ray are normal.

Step 2: Order all relevant investigations

Review Initial ECG

The rate is 104 bpm, with a regular rhythm. There are ST segment elevations in leads II, III and AvF. No other abnormalities are noted.

Perform New ECG

The rate is 80 bpm, in sinus rhythm. No abnormalities are noted. A troponin-I test is performed as well; the level is 0.0 ng/ml (normal: <0.1)

Coronary Angiography

Coronary angiography reveals a pristine coronary vasculature. Provocation with ergonovine results in coronary spasm with concomitant chest pain.


The echocardiogram appears completely normal with no evidence of structural or valvular defects. The left ventricular ejection fraction is >70%.

Step 3: Select appropriate management

Coronary Stenting
Calcium Channel Blockers
Long-acting Nitrates

Score: ★★☆