Zainea M, Duvernoy W F, Chauhan A, David S, Soto E, Small D
Providence Hospital, Southfield, Mich.
Arch Intern Med. 1994 Nov 14;154(21):2495-8.
Coronary spasm may occur with angiographically normal and diseased coronary arteries. General anesthesia has been described only rarely as a triggering event for coronary artery spasm, and only once before in the presence of angiographically normal coronary arteries. We have now seen three patients presenting with acute ST-segment elevation following induction of general anesthesia with enzyme evidence of myocardial necrosis in two patients. Cardiac catheterization was performed in all three patients with one of the procedures performed on an emergency basis owing to hemodynamic compromise. All three patients demonstrated angiographically normal coronary arteries. The electrocardiograms and coronary arteriograms are presented, and possible mechanisms for the injury pattern seen on the electrocardiogram are discussed. Coronary vasospasm causing an acute injury pattern on the electrocardiogram can be caused by general anesthesia and has to be recognized promptly and treated appropriately to prevent more serious complications.
冠状动脉痉挛可发生于冠状动脉造影正常和病变的情况下。全身麻醉作为冠状动脉痉挛的触发事件仅被极少描述，且此前仅在冠状动脉造影正常时出现过一次。我们现在见到了3例患者，在全身麻醉诱导后出现急性ST段抬高，其中2例有心肌坏死的酶学证据。所有3例患者均接受了心导管检查，其中1例因血流动力学不稳定而进行了急诊检查。所有3例患者的冠状动脉造影均显示正常。现展示心电图和冠状动脉造影图像，并讨论心电图上所见损伤模式的可能机制。全身麻醉可导致冠状动脉痉挛，在心电图上呈现急性损伤模式，必须迅速识别并进行适当治疗，以预防更严重的并发症。
