Zhang Hongyang, Ye Xianglin, Pei Haifeng
Department of Cardiology, The Affiliated Hospital, Southwest Medical University, Luzhou, China.
Department of Cardiology, The General Hospital of Western Theater Command, Chengdu, China.
Front Cardiovasc Med. 2024 Aug 15;11:1398675. doi: 10.3389/fcvm.2024.1398675. eCollection 2024.
Coronary vasospasm (CVS) is a common cardiovascular condition, yet its implications should not be underestimated. Regrettably, the current diagnostic and treatment standards for CVS in China are not standardized, severely affecting the quality of life for patients with this condition.
A 68-year-old male presented to the hospital one month prior due to recurrent chest pain. Coronary angiography (CAG) revealed a mid-segment muscle bridge with plaque formation in the left anterior descending artery, followed by pharmacological balloon angioplasty. The primary diagnosis post-operation was acute non-ST elevation myocardial infarction (NSTEMI) and coronary artery myocardial bridging. This time, the patient experienced nocturnal chest pain with a dynamic increase in troponin levels. Emergency CAG showed the left anterior descending and right coronary arteries were fine, with segmental narrowing reaching 95%-99%. Intravascular ultrasound (IVUS) indicated negative remodeling of the mid-segment lumen associated with myocardial bridging, with the smallest lumen area being 2.19 mm. After intracoronary administration of nitroglycerin, the original most narrowed lumen area increased to 8.81 mm. Consequently, a definitive diagnosis of CVS with coronary artery myocardial bridging was made, and the medication treatment plan was promptly adjusted. The patient's symptoms disappeared, and he was discharged. Follow-up after more than three months showed no recurrence of symptoms.
In cases where provocative agents are contraindicated, CAG combined with IVUS can optimize the differential diagnosis of CVS. There is an urgent need in China to improve epidemiological data on CVS and establish standardized diagnostic and treatment protocols.
冠状动脉痉挛（CVS）是一种常见的心血管疾病，但其影响不容小觑。遗憾的是，目前我国CVS的诊断和治疗标准并不规范，严重影响了该病患者的生活质量。
一名68岁男性患者于1个月前因反复胸痛入院。冠状动脉造影（CAG）显示左前降支中段肌桥并伴有斑块形成，随后进行了药物球囊血管成形术。术后初步诊断为急性非ST段抬高型心肌梗死（NSTEMI）和冠状动脉心肌桥。此次，患者出现夜间胸痛，肌钙蛋白水平动态升高。急诊CAG显示左前降支和右冠状动脉正常，节段性狭窄达95%-99%。血管内超声（IVUS）显示与心肌桥相关的中段管腔负性重构，最小管腔面积为2.19 mm。冠状动脉内给予硝酸甘油后，原最狭窄管腔面积增至8.81 mm。因此，确诊为CVS合并冠状动脉心肌桥，并及时调整了药物治疗方案。患者症状消失后出院。3个多月后的随访显示症状未复发。
在激发剂禁忌的情况下，CAG联合IVUS可优化CVS的鉴别诊断。我国迫切需要完善CVS的流行病学数据，并建立规范的诊断和治疗方案。
