The Crucial Role of Sequential Echocardiography in Spastic Angina Assessment

Abstract

Background: Spastic angina, also known as Prinzmetal's angina, causes a temporary contraction of the blood vessels, reducing blood flow to the myocardium and leading to myocardial distress. Spastic angina poses a diagnostic problem, especially with the unavailability of the methyrgine test in some countries and the high risk of possible peri- and post-test complications, including death. Our case highlights the importance of obtaining and comparing echocardiographic data both during the pericardial period and immediately after analgesia in the diagnosis of spasmodic angina without recourse to the methyrgin test. Case Presentation: This case describes a 20-year-old patient, without particular risk factors or toxic habits, who was admitted to hospital because of anginal chest pain at rest, with normal cardiovascular auscultation.  In the per-critical phase, echocardiography showed atypical ST-segment elevation, positive troponins and extensive kinetic disturbances. MRI for suspected myocarditis and coronary angiography for coronary lesions were performed without abnormalities. Post-critical echocardiograms showed partial recovery. Treatment with calcium channel blockers and anti-anginal drugs was started and brought relief, followed by complete recovery of the kinetic abnormalities on follow-up echocardiograms. The diagnosis of spastic angina was confirmed, highlighting the importance of comparing echocardiograms performed per and post critically by the same operator.  Conclusion: This case raises the problem of the positive diagnosis of spastic angina and highlights the value of two comparative echocardiograms by the same operator in the diagnosis and monitoring of spastic angina, for rapid diagnosis and appropriate care to avoid a fatal complication.