Buxton A, Goldberg S, Hirshfeld J W, Wilson J, Mann T, Williams D O, Overlie P, Oliva P
Am J Cardiol. 1980 Aug;46(2):329-34. doi: 10.1016/0002-9149(80)90080-6.
Recent experience has suggested that the ergonovine maleate test is a safe procedure for the diagnosis of variant angina pectoris, because ergonovine-induced coronary vasospasm has generally been reversible by sublingual nitroglycerin. This report describes five cases of ergonovine-induced coronary vasospasm that were refractory to sublingual nitroglycerin. Four of these patients had cardiac arrest. In two patients the vasospasm was responsive to intracoronary nitroglycerin administration. Three patients died as a reuslt of the test. The two survivors differed from the nonsurvivors in the total dose or ergonovine given (0.1 and 0.15 mg versus 0.17, 0.3 and 0.3 mg, respectively) and in the method of administration of ergonovine. The survivors were given serial doses of 0.05 mg each whereas the three nonsurvivors received either larger initial doses (0.1 followed by 0.07 mg) or progressive incremental doses (0.05, 0.1 and 0.15 mg serially). Sublingual nitroglycerin, given to all five patients, and intravenous nitroglycerin, given to three of the five, were ineffective in reversing vasospasm. Intracoronary nitroglycerin favorably altered the course of the survivors. Thus, the ergonovine maleate test is not benign and may cause severe coronary vasospasm that is unresponsive to sublingual and intravenous nitroglycerin, but may be reversed by intracoronary nitroglycerin.
近期经验表明，马来酸麦角新碱试验是诊断变异型心绞痛的一种安全方法，因为麦角新碱诱发的冠状动脉痉挛通常可被舌下含服硝酸甘油逆转。本报告描述了5例舌下含服硝酸甘油难以缓解的麦角新碱诱发的冠状动脉痉挛病例。其中4例患者发生心脏骤停。2例患者的血管痉挛对冠状动脉内给予硝酸甘油有反应。3例患者因该试验死亡。两名幸存者与非幸存者的区别在于给予的麦角新碱总剂量（分别为0.1和0.15毫克，而另外3例为0.17、0.3和0.3毫克）以及麦角新碱的给药方法。幸存者每次给予0.05毫克的连续剂量，而3例非幸存者接受的是更大的初始剂量（0.1毫克后加0.07毫克）或递增剂量（依次为0.05、0.1和0.15毫克）。所有5例患者均给予舌下含服硝酸甘油，5例中的3例给予静脉注射硝酸甘油，但均无法逆转血管痉挛。冠状动脉内给予硝酸甘油使两名幸存者的病情得到改善。因此，马来酸麦角新碱试验并非无害，可能会导致严重的冠状动脉痉挛，对舌下含服和静脉注射硝酸甘油均无反应，但冠状动脉内给予硝酸甘油可能会使其逆转。
