■冠状血管痉挛(CVS)是一种常见的心血管疾病,然而,其影响不应低估。遗憾的是,我国目前对CVS的诊断和治疗标准不规范,严重影响患者的生活质量。
■一名68岁的男性因反复发作的胸痛而在一个月前到医院就诊。冠状动脉造影(CAG)显示左前降支动脉中段肌桥有斑块形成,其次是药物球囊血管成形术。术后主要诊断为急性非ST段抬高型心肌梗死(NSTEMI)和冠状动脉心肌桥。这一次,患者出现夜间胸痛,肌钙蛋白水平动态增加。急诊CAG显示左前降支和右冠状动脉均良好,节段变窄达到95%-99%。血管内超声(IVUS)显示与心肌桥相关的中段管腔负重塑,最小的管腔面积为2.19mm2。冠状动脉内给予硝酸甘油后,最初最窄的管腔面积增加到8.81mm2。因此,明确诊断CVS伴冠状动脉心肌桥,并及时调整用药方案。病人的症状消失了,他出院了.术后随访3个月以上,均无症状复发。
■在禁忌症的情况下,CAG联合IVUS可以优化CVS的鉴别诊断。中国迫切需要改善CVS的流行病学数据,并建立标准化的诊断和治疗方案。
UNASSIGNED: Coronary vasospasm (CVS) is a common cardiovascular condition, yet its implications should not be underestimated. Regrettably, the current diagnostic and treatment standards for CVS in China are not standardized, severely affecting the quality of life for patients with this condition.
UNASSIGNED: A 68-year-old male presented to the hospital one month prior due to recurrent chest pain. Coronary angiography (CAG) revealed a mid-segment muscle bridge with plaque formation in the left anterior descending artery, followed by pharmacological balloon angioplasty. The primary diagnosis post-operation was acute non-ST elevation myocardial infarction (NSTEMI) and coronary artery myocardial bridging. This time, the patient experienced nocturnal chest pain with a dynamic increase in troponin levels. Emergency CAG showed the left anterior descending and right coronary arteries were fine, with segmental narrowing reaching 95%-99%. Intravascular ultrasound (IVUS) indicated negative remodeling of the mid-segment lumen associated with myocardial bridging, with the smallest lumen area being 2.19 mm2. After intracoronary administration of nitroglycerin, the original most narrowed lumen area increased to 8.81 mm2. Consequently, a definitive diagnosis of CVS with coronary artery myocardial bridging was made, and the medication treatment plan was promptly adjusted. The patient\'s symptoms disappeared, and he was discharged. Follow-up after more than three months showed no recurrence of symptoms.
UNASSIGNED: In cases where provocative agents are contraindicated, CAG combined with IVUS can optimize the differential diagnosis of CVS. There is an urgent need in China to improve epidemiological data on CVS and establish standardized diagnostic and treatment protocols.