Stazi F, Meloni C, Ballarotto C
Divisione di Cardiologia, IRCCS H San Raffaele, Milano.
G Ital Cardiol. 1999 Oct;29(10):1208-11.
This case report describes a 48-year-old woman patient with variant angina who died because of severe myocardial ischemia and cardiogenic shock, in spite of chronic therapy with nitrates and calcium-antagonists and acute intravenous administration of nitrates, calcium-antagonists and tissue-type plasminogen activator. Her Holter monitoring showed a reduction of time domain measures of heart rate variability. The hemodynamic study exhibited a normal ventriculography and angiographically normal epicardial coronary arteries. The provocative testing, performed (during intravenous therapy with nitrates and diltiazem) by intracoronary injection of progressively increasing doses of ergonovine, induced only a mild vasoconstriction of proximal left anterior descending artery, without symptoms or ST-T segment changes. This case reminds us that variant angina can be a lethal disease, confirms that a negative result of intracoronary ergonovine testing performed during intravenous therapy with nitrates and calcium-antagonists does not assure the prevention of new episodes during chronic oral therapy with the same drugs, suggests a possible prognostic value of the reduction of heart rate variability indexes and shows an unusual response to nitrate administration.
本病例报告描述了一名48岁的变异型心绞痛女性患者，尽管长期使用硝酸盐和钙拮抗剂治疗，且在急性发作时静脉注射了硝酸盐、钙拮抗剂和组织型纤溶酶原激活剂，但仍因严重心肌缺血和心源性休克死亡。她的动态心电图监测显示心率变异性的时域测量值降低。血流动力学研究显示心室造影正常，冠状动脉造影显示心外膜冠状动脉正常。在静脉注射硝酸盐和地尔硫卓治疗期间，通过冠状动脉内注射逐渐增加剂量的麦角新碱进行激发试验，仅引起左前降支近端轻度血管收缩，无症状或ST-T段改变。该病例提醒我们，变异型心绞痛可能是一种致命疾病，证实了在静脉注射硝酸盐和钙拮抗剂治疗期间进行的冠状动脉内麦角新碱试验阴性并不能确保在使用相同药物进行慢性口服治疗期间预防新的发作，提示心率变异性指标降低可能具有预后价值，并显示了对硝酸盐给药的异常反应。
