Angina di prinzmetal (o angina variante)
Definizione
L’angina di prinzmetal (o angina variante)compare abitualmente in soggetti giovani con episodi anginosi acuti e improvvisi, a riposo e perlopiù nelle ore notturne. In questo contesto vi è il rischio di aritmie ventricolari. Il vasopasmo può avvenire in un vaso sano o a livello di una placca ateromasica. All’ECG si osserva tipicamente un sopraslivellamento del tratto ST che scompare con farmaci vasodilatatori (generalmente NTG sublinguale o intravenosa).
Diagnosi
La diagnosi si basa sulla presenza di un quadro clinico caratteristico e sull’ assenza di stenosi coronariche severe alla coronarografia. Durante il cateterismo si può effettuare un test all’ergonovina, che provoca vasospasmo e serve a confermare la diagnosi.
Terapia
La terapia si basa sulla somministrazione cronica di calcio-antagonisti, a cui si possono aggiungere i nitrati nel caso di mancato controllo dei sintomi. E’ importante evitare i beta-bloccanti che possono provocare vasospasmo coronarico. Le ultime LG della Società Europea di Cardiologia hanno introdotto il concetto MINOCA ( Myocardial Infarction Non Obstructive Artery), includendo in questa famiglia tutti quei casi che si presentano come infarto,in assenza di una lesione coronarica stenosante responsabile della sintomatologia acuta.
Articoli correlati:
Come si manifesta l’angina pectoris? Quanti tipi di angina ci sono? Quanto dura un attacco di angina pectoris? Come si cura l’angina?
L’angina stabile è la forma più frequente di angina pectoris. L’angina pectoris è la manifestazione clinica più frequente della cardiopatia ischemica e la sua causa principale è l’aterosclerosi coronarica Leggi >
Angina instabile: sintomi, prognosi, terapia
Come si cura l’angina instabile? Come viene distinta dall’ infarto miocardico? Che caratteristiche ha il dolore?
Prinzmetal Angina: ECG Changes and Clinical Considerations: A Consensus Paper
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