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Dr. Andrew Rynne

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Can Prinzmetal's angina cause cardiac spasms?

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Dr. Ilir Sharka

Cardiologist

Practicing since :2001

Answered : 5761 Questions

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Posted on Tue, 8 May 2018 in Hypertension and Heart Disease
Question: I went via ambulance to emergency room with crushing pain in left chest and arm. ecg normal, troponin .02, then elevated to .1 er diagnosed nstemi and i was admitted. cardiac CT showed no CAD. Totally clear. cardiologist diagnosed Prinzmetal's angina.
Did I have an MI caused by cariac spasm?
doctor
Answered by Dr. Ilir Sharka 1 hour later
Brief Answer:
I would explain as follows:

Detailed Answer:
Hello!

Welcome and thank you for asking on HCM!

I passed carefully through your question and would explain that coronary spasm (Prinzmetal angina) is not excluded as a possible cause of cardiac ischemia, especially when there is no evidence of atherosclerotic plaques inside the coronary arteries.

The exact culprit factor of coronary spasm in case of chest angina is confirmed when one reversible ST elevation on ECG is observed and furthermore direct coronary spasm is seen during coronary angiography.

Now coming to your concrete question, I would explain that in case you have experienced prolonged chest pain (more than 20 minutes) with ST elevation in the ECG, coupled with the abnormal elevation of cardiac troponin, it may be concluded that you have experienced myocardial infarction.

This conclusion may be exactly confirmed by use of cardiac MRI.

You should discuss with your doctor on the opportunity of performing a coronary angiogram which would more precisely confirm or exclude the real presence of coronary lesions (even when they are not large enough to be seen during cardiac CT).

Hope you will find this answer helpful!

If you have any other questions, please don't hesitate to ask me again!

Kind regards,

Dr. Iliri


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 7 minutes later
my chest pain did last about 35 minutes. no ST elevation was seen then or since. My understanding is clinical presentation of chest pain and troponin elevation is sufficient to conclude MI. Is this correct?
doctor
Answered by Dr. Ilir Sharka 2 hours later
Brief Answer:
Opinion as follows:

Detailed Answer:
Hello again!

You are right about Mi definition: a rise above the upper limit of normal range with any of the following:

- Symptoms of ischaemia.
- New or presumed new significant ST-segment–T wave (ST–T) changes or new left bundle branch block (LBBB),
- Development of pathological Q waves in the ECG,
- Imaging evidence of new loss of viable myocardium or new regional wall motion abnormality,
- Identification of an intracoronary thrombus by angiography

is sufficient for confirming an acute myocardial infarction. (you had prolonged chest pain with increased troponin level).

The additional tests I recommended for a more detailed evidence on the exact pathophysiological reason of myocardial infarction (whether a coronary spasm of others).

At the end, when it comes to MI conclusion, coronary angiography test appears a valuable and justified medical indication.

That's my opinion to this issue.

Wishing you are having a pleasant weekend!

Regards,

Dr. Iliri


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 53 minutes later
so in addition to finding plaques, can angiography find places in the arteries where there has been necrosis?
doctor
Answered by Dr. Ilir Sharka 15 minutes later
Brief Answer:
Several imagine tests may be helpful.

Detailed Answer:
Hello!

Coronary angiography is considered the gold standard test for studying coronary arteries. It reveals the exact locations of coronary lesions (stenoses) and when an acute blockage is suspected, it may also indicate the underlying affected myocardial region.

But, when considering the exact extension of myocardial necrosis, other additional tests give a more precise information. In this regards, a contrast enhanced cardiac MRI or nuclear perfusional cardiac scan are adequate alternatives.

They may detect the necrosis area and subsequent tissue scar and give an overview of myocardial necrosis and its severity.

In addition, cardiac ultrasound is usually helpful in detecting the regions of nonfunctional myocardial walls in the settings of myocardial infarction.

You can discuss with your attending cardiologist on the opportunity of performing any of the above mentioned cardiac imagine tests.

Regards,

Dr. Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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