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有典型变异型心绞痛,冠状动脉狭窄<50％的七例病人,进行踏板运动试验时,发生心绞痛和S—T段抬高。全部病例休息时自发性发作和踏板运动试验时,均在相同的导联中出现S—T段抬高。其中五例病人进行冠状动脉造影时,出现自发性的冠状动脉痉挛。而且心电图在相应的导联中出现S—T段抬高。五例病人,进行运动试验出现心绞痛和S—T段抬高时注入铊,每个病人都在心电图出现S—T段抬高的相应部位出现一大片灌注缺血区,而在休息时检查这些部位,未发现明显的灌注缺损现象。这提示了变异型心绞痛病人,进行运动时可以出现冠状动脉痉挛。变异型心绞痛这个名称,在1959年,由Prinzmetal等人提出以描述一组综合症,其特征是休息时出现心绞痛伴有S—T段抬高。尽管其中一部分病人可以出现严重的近端冠状动脉狭窄,但是,以后的研究证明也可以表现为冠状动脉造影正常。Prinzmetal等人推想暂时的血管张力增加是本综合症的原因。以后在冠状动脉造影时证明,当心绞痛和S—T段抬高时,冠状动脉呈现痉挛现象。所以,一般认为,休息时变异型心绞痛的发生机制是冠状动脉的痉挛。另一方面,典型心绞痛病人或是变异型心绞痛病人,产生劳力性心绞痛时,曾被认为是患者有冠状动脉的固定性狭窄引起的。然而,劳力性心绞痛在变异型心绞痛综合症时并不常见。本报告提出证据说明在一部分变异型心绞痛病人,劳力性心绞痛是可以由冠状动脉痉挛引起的。
Seven patients with typical variant angina and less than 50% of coronary stenosis developed angina and elevated S-T segments during pedaling. S-T elevation occurred in the same lead at all rest episodes spontaneous seizures and treadmill exercise tests. Five of the patients underwent coronary angiography with spontaneous coronary spasm. And ECG in the corresponding leads appear S-T segment elevation. Five patients had exercise test with angina pectoris and thallium influx with S-T elevation. Each patient developed a large area of perfusion ischemia at the corresponding site of S-T elevation in the electrocardiogram, and examined at rest Site, no significant perfusion defect was found. This suggests that patients with variant angina may have coronary artery spasms during exercise. The name of variant angina was proposed by Prinzmetal et al in 1959 to describe a group of syndromes characterized by angina at rest with S-T elevation. Although some of these patients may have severe proximal coronary stenosis, subsequent studies have shown that coronary angiography can be normal. Prinzmetal et al. Hypothesized that temporary increase in vascular tone is the cause of this syndrome. Coronary angiography later proved that when angina pectoris and S-T segment elevation, the coronary artery spasm phenomenon. Therefore, it is generally believed that the mechanism of occurrence of variant angina at rest is coronary spasm. On the other hand, patients with typical angina or variant angina who have exerted angina pectoris were considered to have a stenosed coronary stenosis in their patients. However, exertional angina is uncommon in variant angina pectoris syndrome. This report presents evidence that in some patients with variant angina, angina pectoris is caused by coronary artery spasm.