Which diagnosis best fits a patient with rest angina, transient ST elevations relieved by nitroglycerin, and normal coronary arteries on catheterization?

Which diagnosis best fits a patient with rest angina, transient ST elevations relieved by nitroglycerin, and normal coronary arteries on catheterization?

• A. Prinzmetal angina
• B. Pericarditis
• C. Acute myocardial infarction
• D. Costochondritis

Answer: (A)

This scenario illustrates vasospastic (variant) angina, also called Prinzmetal angina. The key clues are chest pain that occurs at rest, transient ST-segment elevations on ECG, and normal coronary arteries on catheterization. The transient nature of the ST elevations that resolve with nitroglycerin points to a reversible coronary vasospasm rather than a fixed atherosclerotic blockage. Nitroglycerin helps by dilating the coronary vessels and relieving the spasm, which aligns with the clinical picture. This differs from an acute myocardial infarction, where the problem is typically a fixed coronary occlusion with ongoing myocardial injury, usually evidenced by persistent ECG changes and elevated cardiac biomarkers. Pericarditis can also cause ST elevations, but those are usually diffuse and accompanied by PR-segment depression and chest pain characteristics that aren’t relieved by nitroglycerin. Costochondritis presents with chest wall tenderness and no ischemic ECG changes.

This scenario illustrates vasospastic (variant) angina, also called Prinzmetal angina. The key clues are chest pain that occurs at rest, transient ST-segment elevations on ECG, and normal coronary arteries on catheterization. The transient nature of the ST elevations that resolve with nitroglycerin points to a reversible coronary vasospasm rather than a fixed atherosclerotic blockage. Nitroglycerin helps by dilating the coronary vessels and relieving the spasm, which aligns with the clinical picture.

This differs from an acute myocardial infarction, where the problem is typically a fixed coronary occlusion with ongoing myocardial injury, usually evidenced by persistent ECG changes and elevated cardiac biomarkers. Pericarditis can also cause ST elevations, but those are usually diffuse and accompanied by PR-segment depression and chest pain characteristics that aren’t relieved by nitroglycerin. Costochondritis presents with chest wall tenderness and no ischemic ECG changes.