Prinzmetal's angina and atrioventricular conduction disorders

Tracing
N° 58
Library
Pathology
Patient
Young woman 28 years of age, treated with calcium channel blockers in the setting of a Prinzmetal's angina; recurrence of pain occurring in the morning upon waking with 3 episodes of lipothymia; recording of these tracings during an episode of chest pain;
Prinzmetal's angina and atrioventricular conduction disorders
Prinzmetal's angina and atrioventricular conduction disorders
Prinzmetal's angina and atrioventricular conduction disorders
Prinzmetal's angina and atrioventricular conduction disorders
Comments

The prognosis of a Prinzmetal's angina is favorable even if, as on these tracings, a spasm can be complicated by the occurrence of a rhythm disorder or a conduction disorder which can be accompanied by a syncope or sudden death. Some cases of first, second or third degree atrioventricular block have been described in the literature from 12-lead or long-duration ECG-Holter tracings. Conduction disorders occur preferentially during a spasm of the right coronary artery, given the junctional location of the block (ischemia of the branch supplying the atrioventricular node).

The dynamic pattern observed in this patient is characteristic of a nodal disease with successive demonstration of a complete atrioventricular block with narrow QRS (junctional escape), 2:1 block, Wenckebach pattern followed by first degree atrioventricular block (very long PR).

The effect of maximum medical treatment on the occurrence of conduction disorders may be insufficient, involving the need for implantation of a pacemaker even if there are no established expert recommendations in this setting.

Epigraph
The most common occurrence of an atrioventricular block in a Prinzmetal's angina is a spasm of the right coronary artery with nodal localization of the block.