Kiyooka Takahiko, Kobayashi Yoshinori, Ikari Yuji
Division of Cardiology, Tokai University Oiso Hospital, Oiso, Japan,
Cardiovasc Interv Ther. 2014 Oct;29(4):344-9. doi: 10.1007/s12928-013-0237-1. Epub 2014 Jan 10.
A 60-year-old man was admitted with early morning angina while at rest. Coronary angiogram revealed no organic lesions; therefore, a spasm provocation test with ergonovine was performed. Administration of intracoronary ergonovine induced total occlusion of the right coronary artery. The induced total occlusion improved but coronary flow velocity remained severely reduced and chest discomfort with ST-T changes in ECG remained in spite of repeated administration of isosorbide dinitrate (ISDN). Intracoronary administration of nicorandil following ISDN alleviated the chest discomfort, normalized the ST-T change in ECG, and improved the coronary flow. This suggested that microvascular spasm and the epicardial spasm were not relieved by ISDN but by nicorandil. Intracoronary nicorandil injection following ISDN administration may be useful for the diagnosis of microvascular spasm in the ergonovine provocation test.
一名60岁男性因清晨静息性心绞痛入院。冠状动脉造影未发现器质性病变；因此，进行了麦角新碱激发试验。冠状动脉内注射麦角新碱导致右冠状动脉完全闭塞。诱导的完全闭塞有所改善，但冠状动脉血流速度仍严重降低，尽管反复给予硝酸异山梨酯（ISDN），心电图ST-T改变仍伴有胸部不适。在ISDN之后冠状动脉内注射尼可地尔缓解了胸部不适，使心电图ST-T改变恢复正常，并改善了冠状动脉血流。这表明微血管痉挛和心外膜痉挛未被ISDN缓解，而是被尼可地尔缓解。在ISDN给药后冠状动脉内注射尼可地尔可能有助于麦角新碱激发试验中微血管痉挛的诊断。
