Freedman S B, Richmond D R, Kelly D T
Am J Cardiol. 1983 Jul 20;52(2):67A-71A. doi: 10.1016/0002-9149(83)90179-0.
Coronary artery spasm may cause myocardial ischemia in patients without severe coronary atherosclerotic obstruction. Spontaneous rest angina, particularly at night, is the predominant symptom; most patients are smokers. Ergonovine tests have high sensitivity and specificity for the diagnosis of coronary spasm, but should be used when vasospasm is suspected but no electrocardiogram was recorded during spontaneous angina. Arterial constriction measured during ergonovine testing suggests that the arterial hypersensitivity to vasoconstrictors at sites of atherosclerotic lesions is independent of the severity of the lesion. Coronary vasospasm may also be provoked by exercise, possibly through an alpha-adrenergic mechanism. Both spontaneous and exercise-induced attacks of vasospasm are prevented by calcium-antagonist drugs that remain effective during longer-term treatment. The cyclic nature of the condition is demonstrated when successful therapy is discontinued without recurrence of symptoms and may be due to alteration of arterial hypersensitivity.
冠状动脉痉挛可导致无严重冠状动脉粥样硬化阻塞的患者出现心肌缺血。自发性静息性心绞痛，尤其是在夜间，是主要症状；大多数患者为吸烟者。麦角新碱试验对冠状动脉痉挛的诊断具有高敏感性和特异性，但应在怀疑有血管痉挛但在自发性心绞痛发作时未记录到心电图的情况下使用。麦角新碱试验期间测得的动脉收缩表明，动脉粥样硬化病变部位对血管收缩剂的超敏反应与病变严重程度无关。冠状动脉痉挛也可能由运动诱发，可能是通过α-肾上腺素能机制。自发性和运动诱发的血管痉挛发作都可通过钙拮抗剂药物预防，这些药物在长期治疗中仍然有效。当成功治疗停药后症状未复发时，可证明病情具有周期性，这可能是由于动脉超敏反应的改变所致。
