Willberg A, Lieb G, Nunberger D, Hochrein H
III. Medizinische Klinik--Kardiologie, Klinikum Rudolf Virchow (Standort Wedding), Freie Universität Berlin.
Dtsch Med Wochenschr. 1990 Oct 12;115(41):1549-52. doi: 10.1055/s-2008-1065190.
A 49-year-old man developed, over a period of three years, progressively more frequent nocturnal attacks of angina and palpitations. Exercise electrocardiogram was negative. 24-hour Holter monitoring revealed ventricular extrasystoles and tachycardia with ST segment elevations. The dominant left coronary artery, which was free of atherotic changes, went into diffuse spasm after ergonovine administration, accompanied by angina and ventricular extrasystoles. Registration of spontaneous ischaemia confirmed the diagnosis of variant (Prinzmetal) angina. Administration of twice daily 90 mg diltiazem retard and once daily 120 mg isosorbide dinitrate retard at night ended the spasms and with it the attacks of angina and the arrhythmias. This case illustrates that typical angina and ventricular tachyarrhythmias can be caused by spontaneous coronary spasms, even in the presence of normal exercise ECGs and coronary angiograms. If coronary artery spasms are not detectable by ECG, the ergonovine test may further the diagnosis.
一名49岁男性在三年时间里，夜间心绞痛和心悸发作日益频繁。运动心电图检查结果为阴性。24小时动态心电图监测显示有室性期前收缩和伴有ST段抬高的心动过速。左冠状动脉优势型，无动脉粥样硬化改变，给予麦角新碱后出现弥漫性痉挛，伴有心绞痛和室性期前收缩。自发性缺血的记录证实了变异型（普林兹梅尔）心绞痛的诊断。每天两次服用90毫克缓释地尔硫䓬以及每晚一次服用120毫克缓释硝酸异山梨酯后，痉挛停止，心绞痛发作和心律失常也随之消失。该病例表明，即使运动心电图和冠状动脉造影正常，典型心绞痛和室性快速性心律失常也可能由自发性冠状动脉痉挛引起。如果心电图无法检测到冠状动脉痉挛，麦角新碱试验可能有助于诊断。
