- 期刊
Coronary Stenting and Medication in Refractory Variant Angina - A Case Report
冠狀動脈金屬支架置放合併藥物治療於頑固的變異型心絞痛－病例報告
摘要
一位56歲男性因陣發性胸悶合併冒冷汗，喘及瀕臨昏厥有數年之久而至本院就醫。初期對於抗絞痛藥物(amlodipine及isosorbide-5-mononitrate)之反應不佳。運動心電圖顯示胸痛合併胸前導成ST波段上升並產生非持續的心室頻脈，冠狀動脈攝影顯示左前降枝近端有50%的窄縮。根據此二檢查，推測左前降枝近端產生厲害的冠狀動脈痙孿，因而將一冠狀動脈支架置於左前降枝狹宰處。病患在出院以後兩天都沒有症狀，自行停藥，結果在停藥一日後症狀復發，但較為輕微。再一次心導管檢查發現除了支架置放處外的左前降枝均顯示厲害的冠狀動脈痙孿。因此在出院後投予長效型的isosorbide-5-mononitrate, nifedipine及diltiazem，自此之後症狀才消除。此病例證實對於對藥物反應不良頑固的變異型心絞痛，可以冠狀動脈金屬支架置放於窄縮處以減輕症狀，甚至避免致命性的心律不整，但是長效型硝氨鹽及鈣離子阻斷劑不可因而省略不用。(慈濟醫學 2003; 15:185-189)
並列摘要
A 56-year-old man had suffered from intermittent chest tightness with cold sweats, dyspnea and near syncope for years. Amlodipine, trichlrormethiazide and isosorbide-5-mononitrate were prescribed with no relief. A treadmill exercise test disclosed significant exercise related ST-T elevation over the anterior leads accompanied by chest pain. Nonsustained ventricular tachycardia was noted at peak exercise rate. Coronary angiography showed proximal left anterior descending coronary artery (LAD) stenosis (50%). LAD spasm with transient transmural ischemia complicated by ventricular tachycardia was highly suspected. Stenting for this proximal LAD lesion was performed. The patient was readmitted to our hospital 3 days after the procedure because of chest pain. He had ceased taking the prescribed drugs for 1 day. The chest pain severity was, however, far less than before. Repeat coronary angiography revealed a severe left coronary spasm, sparing the stent site. He was well after discharge with medications including isosorbide-5-mononitrate (40 mg), long-acting nifedipine (30 mg) and diltiazem (180 mg). This case demonstrates that coronary stenting is effective for refractory coronary spasm with discrete coronary artery stenosis. It possibly prevented life-threatening arrhythmia. Medications such as nitrates and long-acting calcium channel blockers should be prescribed even after stent placement. (Tzu Chi Med J 2003; 15:185-189)
延伸閱讀
- 許堯欽、謝元凱、王宏銘、廖啟卉、徐尉芳（2020）。心臟房室早期收縮合併陣發性心房顫動與多發性心室頻脈之中醫藥治療病例報告。中醫藥雜誌，31(1)，100-109。https://doi.org/10.6940/JCM.202006_31(1).08
- Chung, C. T. (2003). 以直接介入性冠狀動脈治療處理一服用威而剛後心肌梗塞之病患－病例報告及文獻回顧. Acta Cardiologica Sinica, 19(4), 263-266. https://www.airitilibrary.com/Article/Detail?DocID=10116842-200311-19-4-263-266-a
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- Tsai, J. P., Wang, K. T., Yeh, H. I., & Hou, C. J. Y. (2007). 冠狀動脈瘤形成於Paclitaxel塗藥支架置放術之後. Acta Cardiologica Sinica, 23(1), 50-55. https://www.airitilibrary.com/Article/Detail?DocID=10116842-200703-23-1-50-55-a