Severe Coronary Vasospasm during an Acute Myocardial Infarction with Cardiogenic Shock

嚴重冠狀動脈的痙攣發生於急性心肌梗塞併心因性休克

宋立勤(Li-Chin Sung) ； 陳正熙(Cheng-Hsi Chen) ； 侯嘉殷(Charles Jia-Yin Hou) ； 蔡正河(Cheng-Ho Tsai)

《內科學誌》 16卷3期 (2005/06) Pp. 129-133

https://doi.org/10.6314/JIMT.2005.16(3).04

摘要

冠狀動脈血管痙攣能造成一個暫時的，突然的，顯著的心外冠狀動脈內徑的減少。各種機轉曾被報告過，包括促血管收縮物質，藥物的刺激及神經荷爾蒙的影響。痙攣通常發生在次嚴重或嚴重狹窄處，但它也會發生在血管攝影正常的血管，尤其是亞洲的病人。在急性冠狀動脈症候群的病人（二十到三十八個百分比）比穩定性心絞痛的病人（小於六個百分比）有較高比率會有冠狀動脈血管痙孿。我們報告一個在急性心肌梗塞併發心因性休克時在非梗塞冠狀動脈的痙孿。我們必須謹記這種可能性並做適當正確的處理。

並列摘要

Coronary artery vasospasm can cause a transient, abrupt, marked decrease in the diameter of an epicardial coronary artery. Various mechanisms have been reported, including vasoconstrictor substances, pharmacologic stimuli, and neurohumoral effects. Spasm usually develops at the site of sub-critical or critical stenosis, but it may also occur in angiographically normal arteries, particularly in Asian patients. There appears to be a higher prevalence of coronary spasm in patients with acute coronary syndrome (20% to 38%) than in those with stable angina (＜6%). We report a case of coronary artery spasm of the non-infarct-related arteries during an acute myocardial infarction with cardiogenic shock. This possibility should be kept in mind so that it can be properly managed if present.

並列關鍵字

Acute myocardial infarction ； Cardiogenic shock ； Coronary artery vasospasm