不稳定斑块破裂引起变异性心绞痛1例

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1、·558·心脏杂志(ChinHeartJ)2011，23(4)Prinzmetal’svariantanginacausedbyvulnerableplaquedisruptionYANGHua，SHENZhu-jun(DepartmentofCardiology，PekingUnionMedicalcollegeHospital，PekingUnionMedicalCollege＆Chineseacademyofmedicalscience，Beijing100730，China)Keywords:Var

2、iantangina;Opticalcoherencetomography;vulnerableplaque:PlaquedisruptionIntroduction不稳定斑块破裂引起变异性心绞痛1例杨华，沈珠军(中国医学科学院、北京协和医科大学北京协和医院心内科，北京100730)摘要:背景:典型变异性心绞痛是心绞痛并发心电图一过性ST段抬高，由冠脉痉挛引起。病例:一位68岁男性变异性心绞痛患者，冠脉造影后行光学相干断层扫描(Opticalcoherencetomography，OCT)发现右冠状动脉近端

3、薄壁不稳定粥样斑块破裂。冠脉痉挛是变异性心绞痛的发病机制，而冠脉粥样硬化可能是引起冠脉痉挛的基础疾病，薄壁不稳定粥样斑块的破裂可能是其潜在病因。结论:不稳定斑块破裂可能会引起变异性心绞痛发作。(明确“撕裂”与“破裂”两个病理生理过程)关键词:变异性心绞痛;光学相干断层扫描;不稳定斑块;斑块破裂中图分类号:R541．4文献标识码:B文章编号:1009-7236(2011)04-558-03DOI:CNKI:61-1268/R．20110504．0955．010网络出版时间:2011-5-409:55网络出版地

4、址:http://www．cnki．net/kcms/detail/61．1268．R．20110504．0955．010．html［1］Prinzmetal’svariantanginaischaracterizedbyspon-encedchestpain，12-leadECGshowedsecond-degreetaneousepisodesofchestpainassociatedwithSTseg-AVblock，HR47beat/minute，0.1－0.2mvSTseg-mentelevati

5、oncausedbycoronaryvasospasm．WementelevationinleadsII，III，AVFaswellas0.05－presentacaseofPVAcausedbyvulnerableplaques0.2mvSTsegmentdepressioninleadsV2－6(fig．1)．demonstratedbyOCT．OpticalcoherencetomographyNitroglycerinwasgiven，symptomrelievedwithECG(OCT)isane

6、wintravascularimagingmodalitywithawentbacktonormalin10minutes(fig．2)．Serumcar-highresolutionofapproximately10－20μm，whichisdiactroponinIpeakedat0.09μg/L．Hewasdiagnosedconsideredapromisingapproachtostudyvulnerableunstableangina/Prinzmetal’sVariantAngina(PVA)

7、．［2］plaques．1CasepresentationA68yearsoldmanwasadmittedforrepeatedchesttightnessintheearlymorningatrestfor2days，ac-companiedbydiaphoresisandpalpitation．BaselineECGwasnormalwithheartrateat80beats/minute．Hewasaheavysmoker，andhadbeensufferedfromrecurrentchestd

8、iscomfortatrestinthemorningforseveralyears．Hehadhypertensionwellcontrolledonmedication．Hisexercisecapacitywasgood．HewasFig1ECGshowedsecond-degreeAVblock(arrowindicatedagivenclopidogrel，metoprololandatorvastat