Przybojewski J Z
S Afr Med J. 1983 Jan 22;63(4):103-12.
A middle-aged Coloured man had a 6-year history of chest pain induced by effort and also experienced at rest. Quite dramatic episodes of associated arrhythmias, specifically 'torsade de pointes' (atypical ventricular tachycardia) and syncope were experienced by the patient, despite the use of numerous anti-arrhythmic and anti-anginal agents. Transmural anteroseptal and non-transmural anterolateral myocardial infarctions were documented in the presence of a normal left coronary artery (LCA). Severe reversible vasospasm of the right coronary artery (RCA) was provoked with the use of ergonovine (ergometrine) maleate at cardiac catheterization. It is postulated that the cause of the previous myocardial infarctions was significant vasospasm of the LCA branches, and that he was subject to multiple coronary vasospasm, as was highlighted by the visualization of spasm superimposed on atheromatous plaque within the RCA. Furthermore, it is strongly suggested that the potentially lethal ventricular arrhythmias, including 'torsade de pointes', were a direct result of coronary vasospasm, which in turn gave rise to his presyncope and syncope attacks. No evidence of sinoatrial node disease could be found. The only risk factor for ischaemic heart disease which applied in his case was heavy cigarette smoking. Control of his disabling symptoms seems to have been achieved by the use of maintenance nifedipine (a calcium-blocking agent), long-acting nitrates (isosorbide dinitrate) and quinidine gluconate, confirming the probable vasospastic aetiology of the 'torsade de pointes'. At no stage was there dangerous prolongation of the QT interval, an oft-quoted prerequisite for this arrhythmia. Some of the more important aspects of coronary vasospasm are discussed; as far as I am aware this is the first patient documented in the literature with 'torsade de pointes' associated with angiographically demonstrated coronary artery spasm.
一名中年有色人种男性有6年的胸痛病史，用力时诱发，休息时也会发作。尽管使用了多种抗心律失常和抗心绞痛药物，患者仍经历了相当严重的相关心律失常发作，特别是“尖端扭转型室速”（非典型室性心动过速）和晕厥。在左冠状动脉（LCA）正常的情况下，记录到透壁性前间隔和非透壁性前侧壁心肌梗死。心脏导管检查时使用马来酸麦角新碱（ergometrine）诱发了右冠状动脉（RCA）严重的可逆性血管痉挛。据推测，先前心肌梗死的原因是LCA分支的严重血管痉挛，并且他患有多处冠状动脉痉挛，RCA内动脉粥样硬化斑块上叠加的痉挛可视化突出了这一点。此外，强烈提示包括“尖端扭转型室速”在内的潜在致命性室性心律失常是冠状动脉痉挛的直接结果，进而导致了他的晕厥前期和晕厥发作。未发现窦房结疾病的证据。他的病例中适用的缺血性心脏病唯一危险因素是大量吸烟。通过使用维持剂量的硝苯地平（一种钙阻滞剂）、长效硝酸盐（硝酸异山梨酯）和葡萄糖酸奎尼丁，似乎已控制了他的致残症状，这证实了“尖端扭转型室速”可能的血管痉挛病因。在任何阶段都没有QT间期的危险延长，这是这种心律失常经常提到的一个先决条件。讨论了冠状动脉痉挛的一些更重要方面；据我所知，这是文献中记录的第一例伴有血管造影证实的冠状动脉痉挛的“尖端扭转型室速”患者。
