Aoyama Rie, Sudo Hironao, Okino Shinichi, Fukuzawa Shigeru
Department of Cardiology, Heart and Vascular Institute, Funabashi Municipal Medical Center, 1-21-1 Kanasugi, Chiba 273-8588, Japan.
Eur Heart J Case Rep. 2024 Jul 30;8(8):ytae381. doi: 10.1093/ehjcr/ytae381. eCollection 2024 Aug.
Coronary spastic angina (CSA) in premenopausal women is not frequent but has also been suggested to be associated with oestrogen decline during the menstrual cycle and sometimes becomes refractory and difficult to control. We experienced two premenopausal women with CSA that showed the involvement of the menstrual cycle.
Case 1: 41-year-old-woman had ST-segment elevation and chest pain during urosepsis, just 2 days after the onset of menstruation. The acetylcholine stress test was performed according to the menstrual cycle, and multiple coronary spasms were induced. Case 2: 40-year-old-woman had refractory chest pain as a symptom of premenstrual syndrome (PMS). Coronary angiography on drugs at the maximum dose revealed spontaneous multiple coronary spasms. Blood levels of oestrogen were normal, suggesting that hormonal change may be involved, and the introduction of low-dose pills made free from angina and the reduction of drug dose.
In premenopausal female angina pectoris, oestrogen may play a role; it is important to ask about the menstrual cycle and history of PMS. Besides, the timing of catheterization in premenopausal women with suspected CSA should be considered. Low-dose pills may be effective in some cases, and active medical collaboration with other departments such as gynaecology is desirable. .
绝经前女性的冠状动脉痉挛性心绞痛（CSA）并不常见，但也有人认为其与月经周期中的雌激素下降有关，有时会变得难治且难以控制。我们遇到了两名绝经前患有CSA的女性，她们的症状表现与月经周期有关。
病例1：一名41岁女性在泌尿道感染脓毒症期间，月经开始后仅2天就出现了ST段抬高和胸痛。根据月经周期进行了乙酰胆碱应激试验，诱发了多次冠状动脉痉挛。病例2：一名40岁女性有经前综合征（PMS）症状，表现为难治性胸痛。最大剂量药物下的冠状动脉造影显示有自发性多次冠状动脉痉挛。雌激素血液水平正常，提示可能涉及激素变化，服用低剂量避孕药后心绞痛缓解且药物剂量减少。
在绝经前女性心绞痛中，雌激素可能起作用；询问月经周期和经前综合征病史很重要。此外，对于疑似CSA的绝经前女性，应考虑导管插入术的时机。低剂量避孕药在某些情况下可能有效，与妇科等其他科室积极开展医疗协作是可取的。
