Department of Cardiology, Robert-Bosch-Krankenhaus, Stuttgart, Germany.
Am J Cardiovasc Drugs. 2010;10 Suppl 1:19-26. doi: 10.2165/1153642-S0-000000000-00000.
This review addresses some myths about coronary vasospasm as the cause of angina pectoris. Coronary artery vasospasm is a common phenomenon, which is clinically encountered by busy cardiologists almost on a daily basis. It is the cause of resting angina in many patients without significant coronary artery disease, but also in patients with atherosclerotic coronary artery disease but no subtotal lesion. Although coronary artery vasospasm can be suspected clinically, proof cannot usually be obtained by non-invasive means but is easily available during cardiac catheterization. Patients with vasospastic angina are repeatedly exposed to this invasive procedure as most cardiologists suspect a coronary lesion requiring intervention as the cause of the patient's resting angina. Adding an intracoronary acetylcholine test to the catheterization procedure may establish the correct diagnosis and enable treatment with calcium antagonists and nitrates. Epicardial vasospasm may be observed during the test in patients with and without angiographically visible lesions in the coronary arteries. Almost 50% of all pathological tests, however, do not show epicardial vasospasm but reproduction of symptoms and electrocardiogram signs of ischemia indicating spasm of the microvessels.
这篇综述探讨了一些关于冠状动脉痉挛是心绞痛病因的误解。冠状动脉痉挛是一种常见现象，忙碌的心脏病专家几乎每天都会在临床上遇到。它是许多没有明显冠状动脉疾病的患者静息性心绞痛的原因，也是有动脉粥样硬化性冠状动脉疾病但没有完全病变的患者的原因。尽管可以通过临床怀疑冠状动脉痉挛，但通常不能通过非侵入性手段获得证据，但在心脏导管检查期间很容易获得。由于大多数心脏病专家怀疑冠状动脉病变需要介入治疗是患者静息性心绞痛的原因，因此患有血管痉挛性心绞痛的患者会反复接受这种侵入性程序。在导管插入术过程中添加冠状动脉内乙酰胆碱试验可能会确立正确的诊断，并使钙拮抗剂和硝酸盐治疗成为可能。在冠状动脉有和没有可见血管造影病变的患者中，在测试过程中可能会观察到心外膜血管痉挛。然而，几乎 50%的病理检查并未显示心外膜血管痉挛，但出现了症状和心电图缺血迹象的重现，表明微血管痉挛。
