Aug 03, 2008
If you read anything about me you know I had a Heart Attack in January and been trying to figure out why for the past six months. I have an official diagnosis of microvascular angina (of which prinzmetal angina fits into the larger category).
I just now found the article that ties this rare phenomena together. Tomorrow I have the three spinal MRIs in the afternoon and I am willing to bet that there will be a lesion on my spine to complete this puzzle.
The full article reprint is here at
"A search of the literature reveals a single case report describing a 53-year-old woman diagnosed with multiple sclerosis during a hospital admission for severe angina at rest that was consistent with Prinzmetal angina.4 In their patient, Lalouschek et al4 found ST-segment depression in leads V2 through V6, resolution of pain and electrocardiographic abnormalities with administration of intravenous nitroglycerin, and normal coronary arteries on coronary angiography. Evaluation of lower extremity paresthesias led Lalouschek et al4 to a diagnosis of multiple sclerosis; multiple white matter lesions of the head and thoracic spinal cord were evident on MRI. Because sympathetic preganglionic nerve fibers serving the heart originate in the thoracic spinal cord, Lalouschek et al4 implicated the spinal cord lesion found in their patient as the cause of coronary vasoconstriction. Our 38-year-old patient’s multiple sclerosis relapse may have contributed to coronary vasospasm in a similar fashion. Although her spinal cord was not imaged, head MRI revealed multiple white matter lesions; at least 2 lesions were acute.
The exact mechanisms responsible for coronary artery vasospasm have not been determined, and causes may vary from patient to patient. Willerson et al5 considered the possibilities of changes in autonomic neural control, changes in contractile function, and locally released vasoactive mediators in contact with dysfunctional endothelium. Additional potential contributing factors to our patient’s coronary vasospasm include her history of cigarette smoking,6–8 mental stress,9 and oral contraceptive use"