Iio K, Nandate H, Nakamura T, Nakashima Y, Kuroiwa A
Second Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
J UOEH. 1989 Mar 1;11(1):55-62. doi: 10.7888/juoeh.11.55.
A 48-year-old female, who had been having episodes of chest discomfort and oppression lasting for several minutes for 15 years was diagnosed as having a single left coronary artery by coronary angiography. The electrocardiogram taken during a chest pain attack demonstrated the depression of the ST-segment in leads II, III, aVF, and V4-6. The chest pain was relieved, and the ischemic change in ECG was improved by sublingual nitroglycerine. 201Thalium single photon emission computed tomography under stress indicated poor uptake in both the anterior and infero-posterior myocardium, which was compatible with the change in ECG either during the attack or during exercise. The anterior myocardial ischemia was reduced by propranolol and the chest pain was successfully relieved by propranolol. The chest pain in this case might have partly been due to the myocardial ischemia in the anterior and infero-posterior myocardium, under stress, which could have been the steal phenomenon to lateral myocardium due to the anatomical anomaly, besides other possible mechanisms for chest pain proposed in the case of single coronary artery. Our findings suggested that 201Thalium stress single photon emission computed tomography is a useful method for detecting the myocardial ischemia in patients with single coronary artery and those suffering from chest pain without any coronary stenosis.
一名48岁女性，15年来一直有持续数分钟的胸部不适和压迫感，冠状动脉造影诊断为左冠状动脉单支病变。胸痛发作时的心电图显示Ⅱ、Ⅲ、aVF及V4 - 6导联ST段压低。舌下含服硝酸甘油后胸痛缓解，心电图缺血改变改善。负荷状态下的201铊单光子发射计算机断层扫描显示前壁及下后壁心肌摄取不良，与发作时或运动时的心电图改变相符。普萘洛尔可减轻前壁心肌缺血，并成功缓解胸痛。该病例的胸痛部分可能是由于负荷状态下前壁及下后壁心肌缺血，除单支冠状动脉病例中提出的其他可能的胸痛机制外，还可能是由于解剖异常导致向侧壁心肌的“窃血”现象。我们的研究结果表明，201铊负荷单光子发射计算机断层扫描是检测单支冠状动脉患者及无冠状动脉狭窄的胸痛患者心肌缺血的有用方法。
