Miwa K, Fujita M
Second Department of Internal Medicine, Toyama Medical and Pharmaceutical University, Japan.
Jpn Circ J. 1993 Mar;57(3):167-74. doi: 10.1253/jcj.57.167.
Five patients with variant angina showed alternating ST-segment elevation and contralateral ST-segment depression between the precordial and inferior leads in electrocardiographic recordings made during sequential anginal attacks. This electrocardiographic "seesaw" phenomenon was observed during ergonovine-induced attacks in 3 cases and during spontaneous attacks in 1 case. Another patient showed ST-segment elevation in a spontaneous attack and in other leads during hyperventilation. In all cases, the first attack was accompanied by ST-segment elevation in the inferior leads. Coronary arteriography demonstrated that in all cases, coronary arterial spasm occurred during the attacks in both coronary arterial systems. Significant organic coronary arterial stenoses (> 50%) were found in both the left anterior descending branch and the right coronary artery in 2 patients. The remaining 3 patients showed no significant organic stenoses in any major coronary artery. However, pre-anginal coronary arteriography demonstrated that 13 of the 15 major coronary arteries, including all 9 of the major coronary arteries in the patients without significant stenoses, were already spastic. An exercise stress test performed in the morning induced attacks with chest pain and electrocardiographic ST-segment elevation in all 5 patients. The patients having an alternate ST-segment elevation in separate leads had vasospastic tendencies in both coronary arterial systems.
5例变异型心绞痛患者在连续心绞痛发作期间的心电图记录显示，胸前导联和下壁导联之间ST段抬高与对侧ST段压低交替出现。3例在麦角新碱诱发的发作期间以及1例在自发发作期间观察到这种心电图“跷跷板”现象。另1例患者在自发发作以及过度通气期间其他导联出现ST段抬高。在所有病例中，首次发作均伴有下壁导联ST段抬高。冠状动脉造影显示，所有病例在发作期间两个冠状动脉系统均发生冠状动脉痉挛。2例患者左前降支和右冠状动脉均发现明显的器质性冠状动脉狭窄（>50%）。其余3例患者在任何主要冠状动脉中均未发现明显的器质性狭窄。然而，心绞痛发作前的冠状动脉造影显示，15条主要冠状动脉中的13条，包括无明显狭窄患者的所有9条主要冠状动脉，已经处于痉挛状态。早晨进行的运动负荷试验在所有5例患者中均诱发了胸痛发作和心电图ST段抬高。在不同导联出现交替ST段抬高的患者在两个冠状动脉系统均有血管痉挛倾向。
