Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
J Cardiovasc Med (Hagerstown). 2011 Aug;12(8):578-80. doi: 10.2459/JCM.0b013e32834916ca.
Appropriate diagnosis of patients with chest pain and no significant angiographic coronary artery disease remains challenging. We present the case of a 65-year-old woman with recurrent chest pain that was triggered by exertion as well as emotional stress. She underwent coronary angiography and intravascular ultrasound which demonstrated no atherosclerosis. Coronary flow reserve assessment was also normal suggesting no significant microvascular disease. Intracoronary infusion of acetylcholine, however, resulted in an increase in blood velocity and epicardial vasoconstriction, confirmed by chest pain, electrocardiogram changes and complete closure of a coronary artery by angiography, suggesting the diagnosis of coronary vasospasm or variant angina. This report highlights the importance of considering vasoconstriction when markedly increased blood velocity is observed in response to acetylcholine.
对于胸痛但无明显血管造影冠状动脉疾病的患者的正确诊断仍然具有挑战性。我们报告了一例 65 岁女性的病例，她反复出现胸痛，由体力活动和情绪压力引发。她接受了冠状动脉造影和血管内超声检查，结果显示没有动脉粥样硬化。冠状动脉血流储备评估也正常，提示无明显微血管疾病。然而，冠状动脉内给予乙酰胆碱后，血流速度增加，心外膜血管收缩，胸痛、心电图改变和冠状动脉完全闭塞证实诊断为冠状动脉痉挛或变异型心绞痛。本报告强调了在乙酰胆碱引起的血流速度明显增加时，应考虑血管收缩的重要性。
