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Strange and frightening source of acute chestpain

Prinzmetal Angina is a curious beast: it was first described by the renowned late american cardiologist Myron Prinzmetal (1908 - 1987) in an article in the Journal of the American Medical Association in 1959 and described angina pectoris like central chestpain during periods of rest, associated with typical ECG changes.

Normal angina pectoris is associated with atherosclerosis of the coronary arteries and is caused by obstructive reduction of the arterial bloodflow towards the heartmuscle, causing oxygen defiency in the myocard and subsequently the classic central chestpain. This typically happens on exertion.

In Prinzmetal Angina pre-existing atherosclerotic plaques don't necessarily have to be present, as the pain and oxygen deficiency is caused by spontaneous contracting of the smooth muscles in the arterial wall, causing the artery's lumen to shrink. These symptoms happen at rest and often wake the patient up during the night.

The symptoms can be triggered by alcohol, cocaine and alkaloids like ergotamine and can sometimes be associated with violent cardiac arrythmias. Treatment with a beta blocker or calcium channel blocker is proven to be the most effective.

Oxford Handbook of clinical Medicine

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