1. During rounds on the morning after Mr.

Green’s admission, the attending cardiologist mentioned

Prinzmetal angina as a possible diagnosis. More so, Prinmetal angina usually occurs at times of minimal
or no exertion has been demonstrated to be due to coronary artery spasm. What is Prinzmetal angina?
Does coronary artery spasm ever occur during periods of increased myocardial oxygen demand?
a. Prinzmetal angina also known as variant angina is a syndrome typically consisting of episodic
angina at rest, it is also associated with an reversible ST-segment elevation. Prinmetal angina is
caused by vasospasm of the coronary arteries which is caused by contraction of the smooth
muscle tissue in the vessel walls, thus, there is reduction of blood supply to the heart causing
chest pain. Vasospasm of the coronary arteries may be caused by: Endothelial abnormalities, the
release of Thromboxane A2, the increased of the alpha-adrenergic receptor, and other factors
such as stress, hypomagnesemia, smoking, and exposure to cold weather.
b. Yes, coronary artery spasm may occur during periods of increased myocardial oxygen demand,
because during the increase of demand of the blood vessels for oxygen, there is an increase of
cardiac contractility, wherein the blood vessels contracts in order to give enough blood supply
the heart will need. This contraction is influenced by the release of epinephrine, with this release,
it may contribute to the presence of coronary artery spasm, thus, there may be spasms present
due to the excess release of epinephrine to the heart for it to provide adequate oxygen.
References
(n.d.). Retrieved April 09, 2018, from
http://www.heart.org/HEARTORG/Conditions/HeartAttack/DiagnosingaHeartAttack/Prinzmetals-or-
Prinzmetal-Angina-Variant-Angina-and-Angina-Inversa_UCM_435674_Article.jsp#.Wssc5qhubDd
Slavich M, Patel RS. Coronary artery spasm: Current knowledge and residual uncertainties. International
Journal of Cardiology Heart & Vasculature. 2016;10:47-53. doi:10.1016/j.ijcha.2016.01.003.