Slutzker D M, Capeless M A, Brown K A
Department of Medicine, University of Vermont, College of Medicine, Burlington.
Clin Cardiol. 1990 Mar;13(3):221-3. doi: 10.1002/clc.4960130314.
Left subclavian stenosis is an uncommon cause of exertional left arm pain. In a patient who presented with exertional chest and left arm pain in an increasing pattern, clinical evaluation disclosed a discrepancy between right and left arm blood pressure. Exercise stress testing with thallium revealed normal myocardial perfusion. Aortic arch and selective angiography revealed a high-grade proximal left subclavian stenosis. Subclavian angioplasty was performed with complete resolution of symptoms. This case demonstrates that ischemic left arm pain due to subclavian stenosis can present as accelerated angina, and highlights the importance of determining blood pressure in both arms in routine evaluation of patients at risk for atherosclerosis.
左锁骨下动脉狭窄是劳力性左臂疼痛的罕见原因。在一名出现劳力性胸痛和左臂疼痛且症状逐渐加重的患者中，临床评估发现左右臂血压存在差异。铊运动负荷试验显示心肌灌注正常。主动脉弓和选择性血管造影显示左锁骨下动脉近端高度狭窄。进行了锁骨下动脉血管成形术，症状完全缓解。该病例表明，锁骨下动脉狭窄所致的缺血性左臂疼痛可表现为恶化型心绞痛，并强调了在对有动脉粥样硬化风险的患者进行常规评估时测量双臂血压的重要性。
