John A. Giddings

Variant angina: case reports and critique.

Abstract Variant angina, as herein described in three patients, is a rare clinical entity characterized by episodes of spontaneous pain and is rarely related to exertion. Marked elevation of the J point is common, although not invariable, and dysrhythmias, although characteristic and dramatic, are rare. It is distinguishable from preinfarction angina, with which it is often confused, by its chronicity. Coronary arteriography should be utilized early in an effort to identify obstruction in a single large coronary vessel because of the important possibility of serious dysrhythmias and sudden death.

Clinicoarteriographic Correlations in Angina Pectoris With and Without Myocardial Infarction

Previous studies have emphasized the essential similarity of arteriographic lesions in patients with angina pectoris and in those with acute myocardial infarction. In this study of 30 consecutive patients who underwent coronary arteriography for prolonged, severe angina, 15 had a history or electrocardiographic evidence of prior myocardial infarction and 15 did not. The frequency of intercoronary circulation and the presence of a rudimentary (“filamentous”) vessel distinguished the group with infarction, whereas the presence of focal bridging alone was characteristic of those with angina pectoris. The thesis is offered that angina is the result of proximal major vessel stenosis, with inadequate service by collateral circulation, and that the findings with infarction although quantitatively similar, result eventually in complete obstruction, often with retrograde flow in a major vessel. Such a working hypothesis suggests that minor degrees of myocardial damage are explicable in terms of major vessel constriction with resultant injury at the subendocardial level.

Left ventricular dyskinesia in infarction and angina

In 29 patients, the site and extent of coronary artery obstruction were related to the position and area of abnormally contracting segments of the left ventricle, both in patients with a history of angina without myocardial infarction (group I) and in patients with prior documented myocardial infarction (group II). The degree of coronary artery obstructive disease was estimated in the standard manner and also by a coronary artery index which considered not only the degree of obstruction but also the total length of the obstructed segment. A kinetic or dyskinetic segments were present in 22 of the 29 patients. An abnormally contracting segment was present in 12 or 18 patients without prior myocardial infarction in comparison with 10 of the 11 patients with prior infarction. Complete obstruction of a coronary vessel and resultant dyskinesia were more frequent in the right coronary artery than in either the left anterior descending or the circumflex artery. There was a significant correlation between total per cent of vessel obstruction and degree of ventricular asynergy in both groups; consideration of length of obstructed segment did not improve this correlation.