Gravino F N, Perloff J K, Yeatman L A, Ippolitti A F
Am J Med. 1981 Jun;70(6):1293-6. doi: 10.1016/0002-9343(81)90841-x.
In this report we show that coronary arterial and esophageal spasm are sometimes clinically indistinguishable. Pain patterns can be identical, nitroglycerin can bring relief, interval electrocardiograms and exercise electrocardiograms generally disclose no abnormalities, coronary arteriograms may be within normal limits or nearly so, and, importantly, an ergonovine provocative test can provoke esophageal spasm accompanied by pain mistaken for Prinzmetal's angina. Accordingly, chest pain in response to the administration of ergonovine is not evidence of coronary arterial spasm without simultaneous arteriographic proof together with changes in the monitoring electrocardiogram. Conversely, gastroenterologists should not expose patients to the risk of ergonovine without prior assurance that the coronary arterial response is normal. Our observations illustrate these points and identify a patient with symptomatic esophageal spasm previously diagnosed as Prinzmetal's angina.
在本报告中，我们指出冠状动脉痉挛和食管痉挛有时在临床上难以区分。疼痛模式可能相同，硝酸甘油可缓解疼痛，动态心电图和运动心电图通常无异常发现，冠状动脉造影可能正常或接近正常，重要的是，麦角新碱激发试验可诱发食管痉挛并伴有被误诊为变异型心绞痛的疼痛。因此，在没有同步血管造影证据及监测心电图变化的情况下，麦角新碱激发试验引起的胸痛并非冠状动脉痉挛的证据。相反，胃肠病学家在未事先确保冠状动脉反应正常的情况下，不应让患者承受麦角新碱的风险。我们的观察结果说明了这些问题，并确定了一名先前被诊断为变异型心绞痛但实际患有症状性食管痉挛的患者。
