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Patient
Young woman 28 years of age, treated with calcium channel blockers in the setting of a Prinzmetal's angina; recurrence of pain occurring in the morning upon waking with 3 episodes of lipothymia; recording of these tracings during an episode of chest pain;
Trace
Atrial sinus activity; third degree atrioventricular block, atrioventricular dissociation, junctional escape rhythm (narrow QRS); ST-segment elevation in the inferior leads (subepicardial lesion); reciprocal depression in leads I, aVL;
Trace
Tracing recorded 30 seconds after the first tracing; regression of the elevation amplitude; type 2:1 second degree atrioventricular block;
Trace
Tracing recorded 30 seconds after the second tracing; regression of the amplitude of the elevation; second degree Wenckebach-type atrioventricular block at the beginning of the tracing followed by first degree atrioventricular block (long PR interval);
Trace
Tracing recorded 30 seconds after the previous tracing; regression of the amplitude of the elevation; persistence of a slightly prolonged PR interval;
Trace
Tracing recorded 30 seconds after the previous tracing; complete normalization of the tracing;
Exergue
The most common occurrence of an atrioventricular block in a Prinzmetal's angina is a spasm of the right coronary artery with nodal localization of the block.
The prognosis of a Prinzmetal's angina is favorable even if, as on these tracings, a spasm can be complicated by the occurrence of a rhythm disorder or a conduction disorder which can be accompanied by a syncope or sudden death.