Trillos Donaldo, Krajcer Zvonimir, Lufschanowski Roberto, Leachman Robert D., Klima Tomas, Cooley Denton A.
Divisions of Cardiology, Pathology and Surgery of St. Luke's Episcopal Hospital and the Texas Heart Institute, Houston, Texas.
Cardiovasc Dis. 1980 Mar;7(1):95-103.
A 55-year-old man was referred for the evaluation of frequent chest pain and syncope. While in the hospital, he experienced severe chest pain accompanied by transient ST segment elevation and a slight elevation of cardiac enzyme levels. Multiple coronary arteriograms were recorded at various times during an interval of 2 months. On one occasion, the results were normal; on another occasion, they showed total occlusion of the left anterior descending, diagonal, and circumflex coronary arteries. The occlusion was completely relieved with sublingual nitroglycerin. Because the patient's clinical condition deteriorated rapidly, double aortocoronary saphenous vein bypass was performed to the left anterior descending and circumflex coronary arteries. During the induction of anesthesia, ventricular fibrillation occurred, and the patient died from refractory recurrent fibrillation 4 hours after surgery. Postmortem examination revealed normal coronary arteries, patent vein grafts, and multiple focal areas of recent and old myocardial fibrosis. Thus, it appears that coronary spasm, in the presence of otherwise normal coronary arteries, can produce myocardial infarction with necrosis, and that medical management may provide a more successful method of treating such patients.
一名55岁男性因频繁胸痛和晕厥前来接受评估。在住院期间，他经历了严重胸痛，伴有短暂性ST段抬高和心肌酶水平轻度升高。在2个月的间隔期间，不同时间记录了多次冠状动脉造影。有一次结果正常；另一次则显示左前降支、对角支和回旋支冠状动脉完全闭塞。舌下含服硝酸甘油后闭塞完全缓解。由于患者临床状况迅速恶化，对左前降支和回旋支冠状动脉进行了双主动脉冠状动脉大隐静脉搭桥术。麻醉诱导期间发生室颤，患者术后4小时死于难治性反复室颤。尸检显示冠状动脉正常、静脉移植物通畅，以及多个近期和陈旧性心肌纤维化的局灶性区域。因此，看来在冠状动脉正常的情况下，冠状动脉痉挛可导致心肌梗死伴坏死，药物治疗可能为治疗此类患者提供更成功的方法。
