Nardi Federico, Verna Edoardo, Secco Gioel Gabrio, Rognoni Andrea, Sante Bongo Angelo, Iraghi Gabriele, Bertuol Stefano, Lupi Alessandro
Department of Cardiology, Ospedale Castelli, Italy.
Intern Med. 2011;50(21):2601-6. doi: 10.2169/internalmedicine.50.6086. Epub 2011 Nov 1.
The association of variant angina (VA) and myocardial bridges is a rare finding. We describe a case of VA with recurrent coronary spasm triggered by different stimuli at the site of a myocardial bridge. The interplay of endothelial dysfunction, coronary vasoconstriction and myocardial bridging was detected by intracoronary acetylcholine test and IVUS. We speculate that mechanical stimulation at the bridge site caused endothelial dysfunction and enhanced local susceptibility to vasoconstrictor stimuli. Variant angina should always be suspected in cases of ST-elevation acute coronary syndrome without any significant angiographic coronary stenosis.
变异型心绞痛（VA）与心肌桥的关联是一种罕见的发现。我们描述了一例VA患者，其在心肌桥部位因不同刺激引发复发性冠状动脉痉挛。通过冠状动脉内乙酰胆碱试验和血管内超声检测到内皮功能障碍、冠状动脉收缩和心肌桥之间的相互作用。我们推测，桥部位的机械刺激导致内皮功能障碍，并增强了局部对血管收缩剂刺激的易感性。对于ST段抬高型急性冠状动脉综合征且无任何显著血管造影冠状动脉狭窄的病例，应始终怀疑为变异型心绞痛。
