Prinzmetal's variant of angina oc curred in a 48-year-old man who sus tained two attacks of subarachnoid hem orrhage within 10 days. The first anginal pain started at the same time that the second cerebrovascular accident devel oped, but subsequent anginal episodes were not accompanied by other symp toms or signs that indicated new devel opment of subarachnoid hemorrhage. Twelve days later, when nuchal rigidity was fairly improved, the episodes of chest pain ended. A vasospasm of the large coronary arteries—probably due to the derangement of the autonomic ner vous system caused by subarachnoid hemorrhage—was presumed to contrib ute to the occurrence of the variant an gina. Based on this case and on review of the literature, we propose that coronary arterial spasm is one of several causes of the cardiac changes seen in subarachnoid hemorrhage.
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References
1.
Prinzmetal, M., Kennamer, R., Merliss, R., et al.: Angina pectoris. I. A. variant form of angina pectoris. Preliminary report. Am. J. Med.,27: 375, 1959.
2.
Prinzmetal, M., Ekmekci, A., Kennamer, R., et al.: Variant form of angina pectoris. Previously undelineated syndrome. J.A.M.A., 174: 1794, 1960.
3.
Dhurandhar, R.W., Watt, D.L., Silver, M.D., et al.: Prinzmetal's variant form of angina with arteriographic evidence of coronary arterial spasm. Am. J. Cardiol., 30: 902, 1972.
4.
Cheng, T.O., Bashour, T., Kelser, G.A., et al.: Variant angina of Prinzmetal with normal coronary arteriograms. A variant of the variant. Circulation, 47: 476, 1973.
5.
Oliva, P.B., Potts, D.E., Pluss, R.G.: Coronary arterial spasm in Prinzmetal angina. Documentation by coronary arteriography . N. Engl. J. Med., 288: 745, 1973.
6.
MacAlpin, R.N. , Kattus, A.A., Alvaro, A.B.: Angina pectoris at rest with preservation of exercise capacity. Prinzmetal's variant angina. Circulation , 47: 946, 1973.
7.
Hart, N.J., Silverman, M.E., King, S.B.: Variant angina pectoris caused by coronary artery spasm. Am. J. Med., 56: 269, 1974.
8.
Gaasch, W.H. , Adyanthaya, A.V., Wang, V.H., et al.: Prinzmetal's variant angina: Hemodynamic and angiographic observations during pain. Am. J. Cardiol. , 35: 683, 1975.
9.
Maseri, A., Mimmo, R., Chierchia, S., et al.: Coronary artery spasm as a cause of acute myocardial ischemia in man. Chest, 68: 625, 1975.
10.
Endo, M., Hirosawa, K., Kaneko, N., et al.: Prinzmetal's variant angina. N. Engl. J. Med. , 294: 252, 1976.
11.
Yasue, H., Touyama, M., Kato, H., et al.: Prinzmetal's variant form of angina as a manifestation of alpha-adrenergic receptor-mediated coronary artery spasm: Documentation by coronary arteriography . Am. Heart J., 91: 148, 1976.
12.
Higgins, C.B. , Wexler, L., Silverman, J.F., et al.: Clinical and arteriographic features of Prinzmetal's variant angina: Documentation of etiologic factors. Am. J. Cardiol., 37: 831, 1976.
13.
Meller, J., Pichard, A., Dack, S.: Coronary arterial spasm in Prinzmetal's angina: A proved hypothesis. Am. J. Cardiol., 37: 938, 1976.
14.
Byer, E., Ashman, R., Toth, L.A.: Electrocardiograms with large, upright T waves and long Q-T intervals. Am. Heart J., 33: 796, 1947.
15.
Weintraub, B.M., McHenry, L.C.: Cardiac abnormalities in subarachnoid hemorrhage: A resumé. Stroke, 5: 384, 1974.
16.
Weidler, D.J. : Myocardial damage and cardiac arrhythmias after intracranial hemorrhage. A critical review. Stroke, 5: 759, 1974.
17.
Estanol, B.V. , Marin, O.S.M.: Cardiac arrhythmias and sudden death in subarachnoid hemorrhage. Stroke, 6: 382, 1975.
18.
Smith, M.: Ventricular bigeminy occurring in a case of subarachnoid hemorrhage. J. Electrocardiol., 5: 78, 1972.
19.
Shuster, S.: The electrocardiogram in subarachnoid haemorrhage. Br. Heart J., 22: 316, 1960.
20.
Hersch, C.: Electrocardiographic changes in subarachnoid haemorrhage, meningitis, and intracranial space-occupying lesions. Br. Heart J., 26: 785, 1964.
Abildskov, J.A., Millar, K., Burgess, M.J., et al.: The electrocardiogram and the central nervous system. Prog. Cardiovasc. Dis., 13: 210, 1970.
24.
Eisalo, A., Perasalo, J., Halonen, P.I.: Electrocardiographic abnormalities and some laboratory findings in patients with subarachnoid haemorrhage. Br. Heart J., 34: 217, 1972.
25.
Goldman, M.R. , Rogers, E.L., Rogers, M.C.: Subarachnoid hemorrhage. Association with unusual electrocardiographic changes. J. A. M. A., 234: 957, 1975.
26.
Guazzi, M., Fiorentini, C., Polese, A., et al.: Continuous electrocardiographic recording in Prinzmetal's variant angina pectoris. A report of four cases. Br. Heart J.32: 611, 1970.
27.
Gorfinkel, H.J., Inglesby, T.V., Lansing, A.M., et al.: ST-segment elevation, transient left-prosterior hemiblock, and recurrent ventricular arrhythmias unassociated with pain. A variant of Prinzmetal's anginal syndrome. Ann. Intern. Med., 79: 795, 1973.
28.
Guazzi, M., Olivari, M.T., Polese, A., et al.: Repetitive myocardial ischemia of Prinzmetal type without angina pectoris. Am. J. Cardiol., 37: 923, 1976.
29.
Yasue, H., Touyama, M., Shimamoto, M., et al.: Role of autonomic nervous system in the pathogenesis of Prinzmetal's variant form of angina. Circulation, 50: 534, 1974.
30.
Yasue, H., Touyama, M., Tanaka, S., et al.: Prinzmetal's angina: Atropine suppression. Ann. Intern. Med., 80: 553, 1974.
Hunt, D., McRae, C., Zapf, P.: Electrocardiographic and serum enzyme changes in subarachnoid hemorrhage. Am. Heart J., 77: 479, 1969.
34.
Burch, G.E. , Colcolough, H., Giles, T.: Intracranial lesions and the heart. Am. Heart J., 80: 574, 1970.
35.
Hunt, D., Gore, I.: Myocardial lesions following experimental intracranial hemorrhage: Prevention with propranolol. Am. Heart J., 83: 232, 1972.
36.
Greenhoot, J.H., Reichenbach, D.D.: Cardiac injury and subarachnoid hemorrhage. A clinical, pathological, and physiological correlation. J. Neurosurg., 30: 521, 1969.
37.
Han, J., Moe, C.K.: Nonuniform recovery of excitability in ventricular muscle. Circ. Res., 14: 44, 1964.
38.
Koskelo, P. , Punsar, S., Sipilä, W.: Sub-endocardial haemorrhage and ECG changes in intracranial bleeding. Br. Med. J., 1: 1479, 1964.
39.
Khan, A.H., Haywood, L.J.: Myocardial infarction in nine patients with radiologically patent coronary arteries. N. Engl. J. Med., 291: 427, 1974 .
40.
Ciraulo, D.A. : Recurrent myocardial infarction and angina in a woman with normal coronary angiograms. Am. J. Cardiol. , 35: 923, 1975.
41.
Johnson, A.D. , Detwiler, J.H.: Coronary spasm, variant angina, and recurrent myocardial infarctions. Circulation, 5: 947, 1977.
42.
Melville, K.I. , Garvey, H.L., Shister, H.E., et al.: Central nervous system stimulation and cardiac ischemic changes in monkeys. Ann. N.Y. Acad. Sci. , 156: 241, 1969.
Winbury, M.M. , Howe, B.B., Hefner, M.A.: Effect of nitrates and other coronary dilators on large and small coronary vessels: A hypothesis for the mechanism of action of nitrates. J. Pharmacol. Exp. Ther., 168: 70, 1969.
45.
Cohen, M.V. , Kirk, E.S.: Differential response of large and small coronary arteries to nitroglycerin and angiotensin. Autoregulation and tachyphyraxis . Circ. Res., 33: 445, 1973.
46.
Fleckenstein, A.: On the basic pharmacological mechanism of nifedipine and its relation to therapeutic efficacy, in The Third International Adalat® Symposium. New Therapy of Ischemic Heart Disease . Edited by A. D. Jatene, P. R. Lichtlen.Amsterdam and Oxford, Excerpta Medica, 1976, pp. 1-13.
47.
Endo, M., Kanda, I., Hosoda, S., et al.: Prinzmetal's variant form of angina pectoris. Re-evaluation of mechanisms. Circulation, 52: 33, 1975.
