Soto E, Duvernoy W F, David S, Small D, Nair M R
Section of Cardiology, Providence Hospital, Southfield, Michigan.
Clin Cardiol. 1990 Jan;13(1):59-61. doi: 10.1002/clc.4960130111.
Anesthesia-induced coronary vasospasm has been reported only rarely. We report a case, without previous cardiac history, in which immediately after anesthesia induction a marked ST elevation was noted on the EKG monitor. Premature ventricular contractions as well as non-sustained ventricular tachycardia were noted. These changes resolved immediately after nitroglycerin infusion and 75 mg of lidocaine were given. A coronary angiogram revealed normal coronary arteries and left ventriculogram. Ergonovine stimulation was not performed. The patient was discharged home on calcium entry blockers and nitrates. Exercise stress test two weeks after discharge was negative for ischemia. Induction of anesthesia triggering coronary spasm has been reported rarely, and to our knowledge never in the presence of angiographically normal coronary anatomy. Coronary vasospasm with typical EKG changes--namely, ST elevation and ventricular arrhythmias--has to be included as a possible complication of general anesthesia. Recognition of this syndrome allows prompt treatment and prevention of future episodes.
麻醉诱导的冠状动脉痉挛仅有极少的报道。我们报告一例既往无心脏病史的病例，在麻醉诱导后即刻，心电图监测显示明显的ST段抬高。同时记录到室性早搏以及非持续性室性心动过速。在输注硝酸甘油并给予75毫克利多卡因后，这些变化立即消失。冠状动脉造影显示冠状动脉及左心室造影正常。未进行麦角新碱激发试验。患者出院时服用钙通道阻滞剂和硝酸盐类药物。出院两周后的运动负荷试验显示无缺血表现。麻醉诱导引发冠状动脉痉挛鲜有报道，据我们所知，在冠状动脉造影正常的情况下从未有过报道。伴有典型心电图改变（即ST段抬高和室性心律失常）的冠状动脉痉挛必须被视为全身麻醉可能的并发症之一。认识到这一综合征有助于及时治疗并预防未来发作。
