Two cases of Prinzmetal angina with normal coronary arteries are reported: coronary spasm was demonstrated in the left anterior descending artery in the first, and in the right coronary artery in the second case. Invalidating angina persisted despite maximal medical treatment with nitrite derivatives, nifedipine, verapamil and amiodarone. Homolateral thoracic sympathectomy led to long term remission of symptoms in one case and a short remission in the other, who then had to undergo complete denervation by plexectomy. Two hours after reoperation a refractory spasm of the right coronary artery led to the death of the patient. The possible causes of refractory coronary spasm and possible therapeutic approaches are discussed with reference to these cases.
Adult Angina Pectoris, Variant