Chen Jack P
Department of Cardiology, Saint Joseph's Hospital of Atlanta, Atlanta, GA, USA.
J Invasive Cardiol. 2007 Apr;19(4):E89-92.
Methamphetamine (MET) is a growing public health concern and is prevalent in, although not limited to, the youth. The drug's association with myocardial infarction is well described and is attributed to accelerated atherosclerosis, hypercoagulable state, and macrovascular epicardial coronary spasm. However, global slow-flow of all coronary systems in the absence of significant stenoses has not been previously reported. We hereby present a young patient who likely experienced severe, global microvascular coronary spasm unrelieved by intracoronary vasodilator therapy, resulting in acute myocardial infarction. The pharmacology of MET, its postulated mechanism in acute coronary syndromes, as well as the pathophysiology and treatments of microvascular coronary spasm are briefly reviewed. Readers are recommended to be vigilant of potential illicit drug use in patients with atypical presentations of acute coronary syndromes.
甲基苯丙胺（MET）日益引起公众对健康的关注，且在年轻人中普遍存在，不过不仅限于此群体。该药物与心肌梗死的关联已有详尽描述，其原因在于加速动脉粥样硬化、高凝状态以及大血管心外膜冠状动脉痉挛。然而，此前尚未有关于在无明显狭窄情况下所有冠状动脉系统整体血流缓慢的报道。我们在此呈现一名年轻患者，其可能经历了严重的、全身性微血管冠状动脉痉挛，冠状动脉内血管扩张剂治疗无法缓解，进而导致急性心肌梗死。本文简要回顾了甲基苯丙胺的药理学、其在急性冠脉综合征中的假定机制，以及微血管冠状动脉痉挛的病理生理学和治疗方法。建议读者对急性冠脉综合征非典型表现的患者中潜在的非法药物使用保持警惕。
