Angina Prinzmetal Ischemia

Do not give dihydroergotamine to patients with ischemic heart disease (angina pectoris, history of Ml, documented silent ischemia) or to patients who have clinical symptoms or findings consistent with coronary artery vasospasm, including Prinzmetal variant angina. 

Contraindications Basilar or hemiplegic migraine, coronary artery disease, ischemic heart disease (including angina pectoris, history of Ml, silent ischemia, and Prinzmetal s angina), uncontrolled hypertension, use within 24 hours of ergotamine-contain-ing preparations or another serotonin receptor agonist, use within 14 days of MAOls... 

IV use ischemic heart disease silent ischemia, Prinzmetal s angina, uncontrolled hypertension, concurrent ergotamine-containing preparations, hemiplegic or basilar migraine Caution with liver and kidney problems... 

As described above, calcium channel blockers should not be administered to most patients with ACS. Their role is a second-line treatment for patients with certain contraindications to /S-blockers and those with continued ischemia despite /S-blocker and nitrate therapy. They are a first-line therapy in patients with Prinzmetal s vasospastic angina and those with cocaine-associated ACS. Administration of either am-lodipine, diltiazem, or verapamil is preferred. Agent selection based on heart rate and LV dysfunction (diltiazem and verapamil contraindicated in patients with bradycardia, heart block, or systolic heart failure) is described in more detail in the section Early Pharmacotherapy for ST-Segment-Elevation ACS above. Dosing and contraindications are described in Table 16-4. 

Variant (Prinzmetal s) Angina Hypoxia and ischemia to myocardium is caused by vasospasm (rather than progressive narrowing of coronary arteries). Episodes may occur at rest, often at the same time each day. S-T elevation on ECG. 

---