Tanabe Y, Yamazoe M, Igarashi Y, Tamura Y, Tsuchida K, Otsuka K, Uchiyama H, Shu T, Shibata A
First Department of Internal Medicine, Niigata University School of Medicine, Japan.
Jpn Heart J. 1992 Mar;33(2):135-44. doi: 10.1536/ihj.33.135.
To examine the role of coronary artery spasm in patients with syncope after alcohol ingestion, we performed an intracoronary ergonovine provocation test in 7 male patients (39 to 73 years old, mean 54 years) with alcohol-related syncope which remained unexplained despite noninvasive cardiovascular and neurological examinations. No patients had structural heart disease or significant coronary artery stenosis. Ergonovine was continuously infused into each coronary artery at a rate of 10 micrograms/min for up to 5 min. Coronary artery spasm with ST-segment elevation was induced in 4 of 7 patients. Chest pain before syncope or history of chest pain were not present in 3 of 4 patients with a positive ergonovine test. Multivessel coronary artery spasm was induced in 3 patients. One patient presented with triple vessel coronary artery spasm progressing to near syncope as a result of profound hypotension and ventricular tachycardia during provocation. Coronary artery spasm was promptly relieved by intracoronary isosorbide dinitrate infusion. All patients with a positive ergonovine test were treated with calcium antagonist and did not experience syncope during follow-up. These results suggest that coronary artery spasm is one of the important causes of syncope after alcohol ingestion.
为了研究冠状动脉痉挛在酒精摄入后晕厥患者中的作用，我们对7例男性患者（年龄39至73岁，平均54岁）进行了冠状动脉内麦角新碱激发试验，这些患者患有与酒精相关的晕厥，尽管进行了无创心血管和神经学检查，但仍原因不明。所有患者均无结构性心脏病或明显的冠状动脉狭窄。麦角新碱以10微克/分钟的速率持续注入每条冠状动脉，持续5分钟。7例患者中有4例诱发了伴有ST段抬高的冠状动脉痉挛。4例麦角新碱试验阳性的患者中，有3例在晕厥前无胸痛或胸痛病史。3例患者诱发了多支冠状动脉痉挛。1例患者在激发试验期间出现三支冠状动脉痉挛，由于严重低血压和室性心动过速进展为接近晕厥。冠状动脉内注入硝酸异山梨酯后，冠状动脉痉挛迅速缓解。所有麦角新碱试验阳性的患者均接受了钙拮抗剂治疗，随访期间未再发生晕厥。这些结果表明，冠状动脉痉挛是酒精摄入后晕厥的重要原因之一。
