College of Medicine, University of Central Florida; Orlando, Florida.
Department of Internal Medicine, HCA Healthcare Greater Orlando; Orlando, Florida.
Tex Heart Inst J. 2022 Mar 1;49(2). doi: 10.14503/THIJ-20-7357.
Acute vasospastic angina, formerly known as Prinzmetal angina, is characterized by transient electrocardiographic changes that are not related to exertion. Its atypical presentation makes it difficult to establish the diagnosis, so it is probably underrecognized and therefore mismanaged. We treated a 49-year-old woman who presented with a 2-day history of chest pain associated with palpitations. Abnormal radionuclide stress test results prompted diagnostic coronary angiography, during which the patient reported chest pain and became hemodynamically unstable. Active coronary vasospasm at multiple sites was treated with intracoronary nitroglycerin and nicardipine, leading to immediate recovery. Our case highlights the importance of accurate, timely diagnosis of vasospastic angina, and of early recognition and management of spontaneous coronary spasm during angiography.
急性血管痉挛性心绞痛，以前称为变异型心绞痛，其特征为与体力活动无关的短暂心电图改变。其不典型的表现使其难以建立诊断，因此可能被低估和治疗不当。我们治疗了一位 49 岁的女性，她有 2 天的胸痛伴心悸病史。异常的放射性核素应激试验结果促使进行诊断性冠状动脉造影，在此期间患者报告胸痛并出现血液动力学不稳定。多处冠状动脉痉挛采用冠状动脉内硝酸甘油和尼卡地平治疗，立即得到缓解。我们的病例强调了准确、及时诊断血管痉挛性心绞痛的重要性，以及在血管造影期间早期识别和处理自发性冠状动脉痉挛的重要性。
