Diagnosis of prinzmetal’s angina
The main challenge in diagnosing Prinzmetal’s angina is differentiating it from conditions displaying similar symptoms. Several methods can achieve this:
- A comprehensive medical history of the patient, and especially a description of the patient’s symptoms and how they develop, when they occur, and whether they are associated with effort or not.
- To differentiate it from unstable angina, however, would need additional tools and investigations. The primary studies used for the diagnosis of vasospastic angina include:
- Lab studies as serum levels of lipids to help exclude atherosclerosis of the coronary arteries.
- Cardiac enzymes, since they are released when cardiac muscle cells die, is a good indicator of the degree of deprivation of the heart from blood -also known as ischemia-.
- Since chest pain has various causes, traditional cardiac imaging as a transthoracic echocardiogram can help exclude other common causes of chest pain related to the heart as pericarditis, which is the inflammation of the heart’s covering- and aortic aneurysm or dissection -changes in the wall of the aorta-.
- Electrocardiography, which is a measurement of electrical activity across the heart. In vasospastic angina, a particular pattern of electrical abnormality is noticed when the electrical signal passes across the ventricles. However, this is not seen in between attacks, and thus not very useful in the diagnosis if it is done in an outpatient clinic. To solve this, an ambulatory ECG is used where the ECG electrodes are attached to the body for a day or more to record the event when it occurs.
- Angiography may also be used. It is an imaging technique that is directed towards the blood vessels of the heart. It can demonstrate whether the coronaries are atherosclerotic or not and visualize the site of spasm. It can also be used in provocative tests, where certain substances as ergonovine -a fungal alkaloid- are injected intravenously to detect whether they cause spasm of coronary arteries or not. This type of tests tries to simulate how susceptible are arteries to spasm.
