Yasue H, Omote S, Takizawa A, Nagao M, Miwa K, Tanaka S
Circulation. 1979 May;59(5):938-48. doi: 10.1161/01.cir.59.5.938.
Thirteen patients with Prinzmetal's variant angina performed treadmill exercise tests in the early morning and in the afternoon of the same day. The attacks with ST elevation were induced repeatedly in all 13 patients in the early morning, but in only two patients in the afternoon. Propranolol did not suppress the exercise-induced attacks in all 13 patients. Diltiazem suppressed the attacks in all 13 patients and phentolamine in eight of the nine patients. Coronary arteriograms demonstrated that spasm occluding completely or almost completely the large coronary artery supplying the area of myocardium showing ST elevation appeared during the attacks and disappeared along with the attacks after nitroglycerin administration in all four patients in whom the attacks were induced by arm exercise in the catheterization laboratory. We conclude that there is circadian variation of exercise capacity in patients with Prinzmetal's variant angina caused by coronary arterial spasm induced by exercise in the early morning but not in the afternoon.
13例变异型心绞痛患者于同一天清晨和下午进行了平板运动试验。13例患者在清晨均反复诱发了ST段抬高型发作，但下午仅2例患者出现发作。普萘洛尔未能抑制所有13例患者的运动诱发发作。地尔硫卓抑制了所有13例患者的发作，酚妥拉明抑制了9例患者中的8例。冠状动脉造影显示，在导管实验室通过手臂运动诱发发作的所有4例患者中，发作期间出现痉挛，完全或几乎完全阻塞供应显示ST段抬高心肌区域的大冠状动脉，硝酸甘油给药后痉挛随发作消失。我们得出结论，变异型心绞痛患者存在昼夜运动能力变化，这是由清晨运动诱发的冠状动脉痉挛引起的，而下午运动则不会诱发。
