Fleck E, Auch-Schwelk W, Frantz E, Krackhardt F, Oswald H, Sauer H U
Klinik für Innere Medizin-Kardiologie, Deutsches Herzzentrum Berlin.
Z Kardiol. 1993;82 Suppl 5:23-32.
Rupture of atheromatous plaques, thrombosis and spastic contractions cause dynamic lesions in coronary arteries. This review focuses on the diagnostic approach to vasospastic lesions. Our current knowledge considers vasospastic angina as a--most likely--localized disease of the vascular smooth muscle, which occurs in nonatherosclerotic as well as in atherosclerotic segments. Currently the diagnosis can only be proven by functional tests under angiographical control. Since the pathophysiological mechanisms leading to vasospasm remain unclear, only empirically developed pharmacological tests are available. The use of ergonovine alkaloids is well established, the feasibility of acetylcholine is under investigation. The reproducibility regarding the course of the disease and the localization of the lesion has not yet been determined. The necessity to state the diagnosis is given by the improved prognosis of the disease under effective therapy with calcium channel blockers and nitrates.
动脉粥样硬化斑块破裂、血栓形成和痉挛性收缩会导致冠状动脉出现动态病变。本综述重点关注血管痉挛性病变的诊断方法。我们目前的认知认为，血管痉挛性心绞痛很可能是一种血管平滑肌的局限性疾病，它发生在非动脉粥样硬化以及动脉粥样硬化节段。目前，只有在血管造影控制下通过功能测试才能证实诊断。由于导致血管痉挛的病理生理机制尚不清楚，目前只有根据经验开发的药理测试方法。麦角生物碱的应用已得到充分证实，乙酰胆碱的可行性正在研究中。疾病进程和病变定位的可重复性尚未确定。在使用钙通道阻滞剂和硝酸盐进行有效治疗的情况下，疾病预后得到改善，因此有必要明确诊断。
