Young woman 42 years of age, smoker, hospitalized for repeated episodes of chest pain since several days occurring in the morning at rest; recording of an electrocardiogram in the department during an episode of pain;

Trace

Sinus rhythm, normal PR interval; major elevation exceeding 10 mm in inferior leads, beginning at the peak of the R wave, encompassing the T-wave and constituting a monophasic dome-shaped wave; reciprocal depression in leads I, aVL, V3-V5; ventricular extrasystole followed by ventricular couplet;

Trace

Tracing recorded a few minutes after the administration of 2 puffs of sublingual nitroglycerine which led to the resolution of chest pain; the modifications in the ST-segment disappeared; the amplitude of the R wave in the inferior leads is lower on this tracing than in the first tracing (increase of the R wave during the crisis);

Comments

This patient presents a Prinzmetal's angina with spasm of the right coronary artery. The electrocardiogram and clinical presentation are characteristic: high transient elevation spontaneously ceasing or after administration of sublingual nitroglycerine.

Exergue

Chest pain typical of Prinzmetal's angina is recurrent, self-limiting, preferentially occurring at night or early in the morning and may be favored by a specific triggering factor (tobacco, cocaine use, cold environment, etc). The electrocardiogram during pain (when it can be recorded) shows a transient ST-segment elevation.