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An emphasis is placed on the definition and separation of the acute coronary insufficiency from the other "status anginosus", because the natural history and its physiopathology is of a distinct nature and actually still not very precise. A group of 19 patients was studied which filled all the clinical, electrocardiographic and enzymatic requisites of the genuine acute coronary insufficiency. Among these a subgroup of 13 patients was found with the classic Prinzmetal syndrome. In all cases the following were studied: antecedents, risk and coronary profile, the pain syndrome, electrocardiographic alterations, enzymatic modifications, coronariographic findings modifications, coronariographic findings and the ventricular function through ventriculography. The frequent occurance in the female sex is pointed out as well as the importance of the social and sensorial stress. We effected and described the correlation between the number and intensity of the pain crises and coronariographic findings. The electrocardiographic and coronariographic findings were correlated in the Prizmetal variety as well as in the entire group. An analysis was made of the correlation between the number and degree of coronary obstructions and the areas of ventricular diskinesia. The apparent paradox between an important number of cases with ventricular diskinesia and the limited number of cases with clinical and radiological left ventricular failure was mentioned and discussed. An analysis is made of the theoretic models of the ischemic heart disease in relation to the coronary macro and microcirculation and the possible influence of the catecolamines and the collateral circulation. The different physiopathological mechanisms introduced in this entity whose genuine world wide ocurrence is not very elevated. The evolution and morbi-mortality of those cases placed under medical care is analyzed.