Takahashi Hiroshi, Yagyu Seina, Furuya Shingo, Washio Takehiko, Kawauchi Kenji, Kobori Masashi, Matsumoto Naoya, Hirayama Atsushi
Department of Cardiology, Nihon University Hospital, 1-6 Kanda-Surugadai, Chiyoda-ku, Tokyo, Japan.
Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Oyaguchi-Kamimachi, Itabashi-ku, Tokyo, Japan.
Eur Heart J Case Rep. 2018 May 16;2(2):yty061. doi: 10.1093/ehjcr/yty061. eCollection 2018 Jun.
Diagnostic criteria for coronary microvascular spasm (CMS) have not yet been fully established.
We present two cases of CMS in which decreased coronary blood flow velocities were observed during acetylcholine (ACH) provocation tests. The first patient suffered from chest pain occurring while at rest. The patient underwent coronary angiography (CAG), which revealed a decrease in the average peak velocity (APV) from 29 cm/s to 14 cm/s and a slow flow phenomenon following ACH injection. The second patient suffered from chest pain occurring during the night. The patient underwent CAG, which revealed a decrease in the APV from 17 cm/s to 7 cm/s with no significant epicardial coronary artery spasm following ACH injection. Both patients complained of chest pain, and electrocardiogram changes were observed in leads equivalent to the distal area of the vessel during an ACH provocation test. These findings were consistent with CMS, and their conditions improved under medical treatment.
A transient decrease in coronary blood flow velocity following ACH administration might be a phenomenon specific to CMS. These cases may provide some insight into the underlying pathophysiology of CMS.
冠状动脉微血管痉挛（CMS）的诊断标准尚未完全确立。
我们报告两例CMS病例，在乙酰胆碱（ACH）激发试验中观察到冠状动脉血流速度降低。首例患者在静息时出现胸痛。患者接受了冠状动脉造影（CAG），结果显示ACH注射后平均峰值速度（APV）从29厘米/秒降至14厘米/秒，并出现慢血流现象。第二例患者在夜间出现胸痛。患者接受了CAG，结果显示ACH注射后APV从17厘米/秒降至7厘米/秒，且无明显的心外膜冠状动脉痉挛。两名患者均主诉胸痛，且在ACH激发试验期间，与血管远端区域相对应的导联出现心电图变化。这些发现与CMS一致，且他们的病情在药物治疗下有所改善。
ACH给药后冠状动脉血流速度的短暂降低可能是CMS特有的现象。这些病例可能为CMS的潜在病理生理学提供一些见解。
