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Case Reports in Cardiology
Volume 2013 (2013), Article ID 641348, 3 pages
http://dx.doi.org/10.1155/2013/641348
Case Report

A Series of Unfortunate Events: Prinzmetal Angina Culminating in Transmural Infarction in the Setting of Acute Gastrointestinal Hemorrhage

1Beth Israel Medical Center, Albert Einstein College of Medicine, New York, NY, USA
2Rhode Island Hospital, Providence, RI, USA

Received 5 March 2013; Accepted 4 April 2013

Academic Editors: E. Ercan, R. J. Ostfeld, G. Pontone, and D. Richter

Copyright © 2013 Michael Ruisi et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Prinzmetal angina or vasospastic angina is a clinical phenomenon that is often transient and self-resolving. Clinically it is associated with ST elevations on the electrocardiogram, and initially it may be difficult to differentiate from an acute myocardial infarction. The vasospasm induced in this setting occurs in normal or mildly to moderately diseased vessels and can be triggered by a number of etiologies including smoking, changes in autonomic activity, or drug ingestion. While the ischemia induced is usually transient, myocardial infarction and life-threatening arrhythmias can occur in 25% of cases. We present the case of a 65-year-old female where repetitive intermittent coronary vasospasm culminated in transmural infarction in the setting of gastrointestinal bleeding. This case highlights the mortality associated with prinzmetal angina and the importance of recognizing the underlying etiology.