Azuma T, Maeda K, Akagi H, Yamamoto T
Department of Cardiology, Kinan General Hospital, Wakayama.
J Cardiol. 1994 Mar-Apr;24(2):161-5.
A 41-year-old man was admitted because of chest pain at rest. The exercise test and coronary angiography were performed after all antianginal medication was discontinued for 24 hours. During the graded treadmill exercise stress test using the Bruce protocol, the patient had anginal pain with the electrocardiogram (ECG) showing ST segment elevation in leads V1 and V2. A baseline coronary angiogram disclosed 50% stenosis of the first septal branch of the left coronary artery. After a bolus of 0.1 mg ergonovine was administered into the coronary artery, the patient complained of typical anginal pain. Complete occlusion of the first septal branch was demonstrated, associated with significant ST segment elevation in leads V1-V3, right bundle branch block, and electrical axis deviation to the left on the ECG. The coronary occlusion reversed soon after nitroglycerin administration into the coronary artery. We diagnosed a rare case of angina pectoris caused by spasm of the minor branch of coronary artery, and that serial ECG changes might demonstrate ventricular septal ischemia including the cardiac conduction system. ST segment elevation in leads V1-V3 indicated ischemia of the ventricular septum, and right bundle branch block, axis deviation to the left, and increased amplitude of the precordial R wave might be induced by ischemia of the right bundle branch, left anterior bundle branch and septal branch in the cardiac conduction system supplied by the septal branches of the left anterior descending coronary artery.
一名41岁男性因静息时胸痛入院。在停用所有抗心绞痛药物24小时后进行了运动试验和冠状动脉造影。在采用布鲁斯方案的分级平板运动负荷试验过程中，患者出现心绞痛，心电图（ECG）显示V1和V2导联ST段抬高。基线冠状动脉造影显示左冠状动脉第一间隔支狭窄50%。向冠状动脉内注射0.1 mg麦角新碱推注量后，患者诉说典型心绞痛。显示第一间隔支完全闭塞，同时ECG上V1-V3导联ST段显著抬高、右束支传导阻滞及电轴左偏。向冠状动脉内注射硝酸甘油后冠状动脉闭塞很快逆转。我们诊断了一例由冠状动脉小分支痉挛引起的罕见心绞痛病例，并且连续心电图变化可能显示包括心脏传导系统在内的室间隔缺血。V1-V3导联ST段抬高提示室间隔缺血，右束支传导阻滞、电轴左偏及胸前导联R波振幅增加可能由左前降支冠状动脉间隔支供血的心脏传导系统中右束支、左前束支及间隔支缺血所致。
