Variant form of angina pectoris: its clinical features and treatment. The 185th Luis Guerrero Memorial Lecture given at the 6th Paul Dudley White Session, University of Santo Tomas, Manila, The Philippines, January 24, 1979.

The variant form of angina pectoris (VA) is a rather common disease in Japan, and the author himself is suffering from it. Among 100 successive cases of various types of angina seen in our Department, excluding myocardial infarction and post-infarctional angina, 23 cases were VA. The brief duration, cyclic occurrence and frequent incidence of the attacks at night are considered to be the clinical characteristics. The pathogenesis of VA is ascribed to coronary spasm on the basis of findings made in cinecoronary arteriography. ST elevation was observed more frequently on exercise test in VA than in ordinary exertional angina pectoris, indicating that patients with VA are in a markedly spasmophilic state. Although the prognosis is not generally so serious, 33 out of 50 cases of VA had arrhythmias during attacks, including such serious ones as advanced AV block and ventricular fibrillation. Nifedipine was dramatically effective in suppressing repeatedly occurring ventricular fibrillation. A survey of the effects of calcium antagonists in 243 cases of VA in 11 cardiology institutes throughout Japan revealed that these drugs were effective in more than 90% of the cases. Of particular note is the fact that the attacks were completely eliminated in more than 80% of the cases.