An atypical case of vasospastic angina: Demonstrating the usefulness of Holter monitoring

Prinzmetal variant angina or vasospastic angina is a clinical syndrome characterised by episodic chest pain and transient reversible ST segment changes in ECG. The aetiology and treatment of the condition are quite different compared to those of conventional coronary artery disease. The crux of the problem in variant angina patients remains the diagnosis, especially if coexisting coronary artery disease is present. Timely diagnosis not only helps relieve symptoms, it also prevents complications such as ventricular tachycardia. Conventional provocative tests are used for diagnosis of such conditions; they have varied sensitively and specificity, and are cumbersome to perform. We present a case of an elderly man who presented with recurrent episodes of breathlessness and chest pain, where Holter monitoring proved to be a better mode for diagnosing variant angina than more invasive provocative tests. In this report, we reemphasis the role of this simple non-invasive diagnostic mode for diagnosis of variant angina.