Mr. Raymond's chest pain
 
Symptoms & History

Physical Findings

Stop & Think

Lab and X-Ray

Differential Diagnosis

The Disease

Treatment

Conclusions

Quiz & Evaluation

 OK, you got it, vascular spasm wins the prize.

Obviously in the area of his atherosclerosis, spasm can cause critical narrowing. The outcome being transient anginal pain, dramatically relieved by administering a vasodilator.

This particular twist on angina is known as Prinzmetal's variant angina. It's named for Myron Prinzmetal who described all the way back in the 1950's. Here's the skinny:

  • Episodes of chest pain occurring at rest.
  • ST segment elevations on EKG
  • Typically occurs in association with atherosclerosis.
  • Rarely (I emphasize rarely) may be seen in people with normal arteries.
  • Episodes may be accompanied by arrhythmia and even myocardial infarction or sudden death.
There is essentially nothing left to do but make the diagnosis for Mr. Raymond, and here's what to do the next time you hear this story.		  

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