成人胸痛患者におけるSTセグメント上昇。冠動脈血管痙攣の一例

ST segment elevation in an adult chest pain patient: A case of coronary artery vasospasm.

• Venkata Satish Pendela
• Pujitha Kudaravalli
• Mamta Chhabria
• Mallory Balmer-Swain

抄録

胸痛は米国の救急部（ED）に来院する患者の最も一般的な症状の1つであり，年間800万例に上る．我々は，突然発症した胸痛を訴えて救急外来に来院した55歳の男性を紹介する．これらの変化はニトログリセリンの投与で消失した。冠動脈血管造影は正常であったため，冠動脈血管痙攣と診断された．カルシウム拮抗薬が処方され，症状は改善した。最も重要なことは、ST上昇の原因としての冠動脈血管攣縮は見逃しがちであり、胸痛を呈する患者の鑑別の中で考慮すべきであるということである。硝酸塩および／またはカルシウム拮抗薬と誘因の回避が症状管理に役立つ。

Chest pain is one of the most common symptoms of patients presenting to the emergency department (ED) in the United States, accounting for up to eight million cases annually. We present a 55-year-old male who was brought in to the ED with sudden onset chest pain and was found to have ST-segment elevations in the infero-lateral leads on electrocardiogram (ECG). These changes resolved with nitroglycerin. Coronary artery vasospasm was diagnosed as coronary angiogram was normal. Calcium channel blocker was prescribed with good symptom relief. The most important teaching point is, coronary vasospasm as a cause of ST-segment elevation is missed frequently and should be considered among the differentials in patients presenting with chest pain. Nitrates and/or calcium channel blockers along with avoidance of triggers can help in symptom management.

Copyright © 2020. Published by Elsevier Inc.