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Images in cardiovascular medicine. Spontaneous echocardiographic wall motion abnormalities in variant angina.

Variant angina, defined as spontaneous angina pectoris associated with transient ST-segment elevation, is usually caused by episodic coronary spasm. At present, coronary artery spasm is a reversible coronary stenosis that limits coronary blood flow under resting conditions. Prinzmetal first described this type of angina pectoris as a distinct entity in 1959.1

Although several hypotheses have been suggested, the precise mechanism for coronary vasospastic disease remains unclear. Natural history of variant angina is heterogeneous. In most of the cases, the prognosis is good; however, it can lead to myocardial infarction (MI), life-threatening ventricular arrhythmias, and sudden death.

A 51-year-old man, a smoker, who had no history of cardiac disease and who was affected by hepatitis C positive-related cryoglobulinemic glomerulonephritis with mild renal failure, was admitted to the emergency department for sudden, typical chest pain that occurred during a routine nephrologic visit. The 12-lead ECG showed a significant ST-segment elevation in …