Itoh E, Suzuki K, Tanabe Y
Department of Medicine, Shibata Hospital, Niigata, Japan.
Jpn Circ J. 1999 Jun;63(6):493-5. doi: 10.1253/jcj.63.493.
An electrophysiological study and a provocative test of coronary artery spasm was attempted in a 68-year-old man who was having syncopal attacks and chest pain. His electrocardiogram had the characteristics of Brugada syndrome and ventricular fibrillation (VF) was induced by programmed electrical stimulation. ST-segment elevation became exaggerated by procainamide, which could not prevent the induction of VF. Coronary angiography revealed no stenotic lesions, and spasm in the left coronary artery was induced by intracoronary administration of acetylcholine with similar chest pain to that experienced before. Under treatment with diltiazem and flecainide, which suppressed the induction of VF, the patient experienced no recurrence of symptoms despite persistent ST-segment elevation. No previous reports have described coronary spasm associated with Brugada-type ECG abnormalities, and patients with syncope should be evaluated carefully.
对一名患有晕厥发作和胸痛的68岁男性进行了电生理研究及冠状动脉痉挛激发试验。他的心电图具有Brugada综合征的特征，程序电刺激可诱发室颤（VF）。普鲁卡因胺可使ST段抬高加重，但无法预防室颤的诱发。冠状动脉造影未发现狭窄病变，冠状动脉内注射乙酰胆碱可诱发左冠状动脉痉挛，且胸痛与之前发作时相似。在使用地尔硫䓬和氟卡尼治疗以抑制室颤诱发的情况下，尽管ST段持续抬高，但患者症状未再复发。此前尚无关于与Brugada型心电图异常相关的冠状动脉痉挛的报道，对于晕厥患者应进行仔细评估。
