Masugata H, Yasuno M, Hasegawa S, Ito T, Kato J, Nishino M, Ebisuno S, Ohnishi S, Sueyoshi K, Tanahashi H
Department of Medicine, Osaka Rosai Hospital.
Kokyu To Junkan. 1991 Dec;39(12):1251-4.
A 44-year old female with aortitis syndrome complained of precordial pain on effort. Exercise electrocardiograms revealed significant ST segment depression in leads II, III, aVF and V. Coronary arteriograms demonstrated no stenosis. However, the right coronary arteriogram revealed collateral circulation arising from the sinus node artery to the bilateral vertebral arteries and the left internal carotid artery. Collateral vessels in aortitis.syndrome arising from the coronary artery to the lung have been reported sporadically. However, to our knowledge, the collateral circulation from the coronary artery to intracranial vessels as seen in the present case has never been reported. In the present case, the left ventricular hypertrophy was observed on electrocardiograms and echocardiograms. It can not be denied that it was a cause of the angina pectoris. However, exercise myocardial scintigraphy showed transient myocardial ischemia at stress on the inferoposterior wall corresponding to leads II, III, aVF and V on electrocardiograms. Therefore, coronary steal syndrome due to the collateral pathway from the coronary artery may be considered a likely cause of the angina pectoris. The collateral circulation was considered to be an important route of blood flow supply to the brain and, at the same time, a cause of coronary steal syndrome and consequently angina pectoris.
一名患有大动脉炎综合征的44岁女性主诉劳力时心前区疼痛。运动心电图显示II、III、aVF及V导联ST段明显压低。冠状动脉造影未显示狭窄。然而，右冠状动脉造影显示有侧支循环从窦房结动脉至双侧椎动脉及左颈内动脉。大动脉炎综合征中冠状动脉至肺部的侧支血管已有散在报道。然而，据我们所知，本例所见的冠状动脉至颅内血管的侧支循环从未有过报道。在本例中，心电图及超声心动图均观察到左心室肥厚。不可否认这是心绞痛的一个原因。然而，运动心肌闪烁显像显示在负荷状态下下后壁对应于心电图II、III、aVF及V导联处有短暂心肌缺血。因此，冠状动脉侧支途径导致的冠状动脉窃血综合征可能是心绞痛的一个可能原因。该侧支循环被认为是脑血流供应的重要途径，同时也是冠状动脉窃血综合征及心绞痛的一个原因。
