Variant angina induced by alcohol ingestion.

A 49-year-old man had episodes of angina pectoris in the middle of the night only when he had ingested alcoholic beverage in the evening. Electrocardiograms at rest and after exercise were completely normal. An anginal attack with remarkable ST elevation in leads V1 through V5 was successfully provocated every night when he ingested alcohol and no attacks occurred when he did not take alcohol. The decay curve of ethanol concentration in blood after the ingestion of alcohol was normal. A coronary arteriography revealed 50% stenosis of the proximal portion of the left anterior descending artery, 50% stenosis of the distal portion of the left circumflex artery and the normal right coronary artery. It was suggested that the direct effect of ethanol was not responsible to his attack because the ethanol level at the time of the attack was quite low, but autonomic imbalances resulted from the late effects of alcohol ingestion might be responsible to the spasm of the coronary artery. We report a patient with Prinzmetal's variant angina in whom attacks were induced only in the night when he ingested alcoholic beverage. Only one report of such a case was bibliographically found and this is the second case with variant angina induced by alcohol ingestion.