Review Articles 베타수용체차단제유발검사로진단된이형협심증과 이유발검사에의해생긴심내막하경색증 1 예 Abstract 장재남 * 지동한 박기수 이기훈 조성욱 고광곤 조상균 김순혜 김삼수 Variant Aangina Diagnosed by Bet

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인서 오
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1 Review Articles 베타수용체차단제유발검사로진단된이형협심증과 이유발검사에의해생긴심내막하경색증 1 예 Abstract 장재남 * 지동한 박기수 이기훈 조성욱 고광곤 조상균 김순혜 김삼수 Variant Aangina Diagnosed by Beta-Blocker Provocation Test and a Case of Subendocardial infarction Induced by This Test A Case Report Jae Nam Chang, M.D., Dong Han Chi, M.D., Gi Soo Park, M.D., Ki Hoon Lee, M.D., Seong Wook Cho, M.D., Kwang Kon Koh, M.D., Sang Kyoon Cho, M.D. Department of Internal Medicine, Inha University, College of Medicine, Inchun, Korea Soon Hye Kim, M.D., Sam Soo Kim, M.D. Department of Internal Medicine, Seoul Kangnam Medical Center, Seoul, Korea The provocation test of variant angina are known as ergonovine test, hyperventilation, acetylcholine, exercise and cold pressor test, but beta-blocker provocation test has not been reported as a case. So, this paper reports on the diagnosis of variant angina by beta-blocker provocation test and the case of subendocardial infarction induced by this test. This study reports with literature and investigation about the following case A 45-year-old man with a history of recurrent episode of typical angina on the early morning for the past 20 days. He was administrated beta-blocker given by oral route, and on the next morning there was chest pain as same degree as before, Holter EKG displayed ST segment elevation and ventricular tachycardia. It was confirmed focal spasm on coronary angiography, ST segment elevation on EKG, and newly developed hypokinesia on left ventriculogram and followed-up echocardiography. When the chest pain is absent, EKG was normal. And we confirmed that the elevation of cardiac enzyme was absent as a result of serial follow up study. KEY WORDSBeta-blocker Variant angina Subendocardial infarction. 559

2 서론 증례 Fig. 1. Beta-blocker 투여후 24 시간심전도상 V5 에서나타난 ST 분절상승과심실성빈맥. 560

폐쇄되는 것을 볼 수 있었고(Fig. 2-B), 이때 흉통과 여 주기적으로 반복되던 자발적인 협심증상이 완전히 더불어 심전도 소견상 V2-6까지 ST분절의 상승이 관 소실되었으며 현재 외래 추적관찰중이다. 찰되었으며(Fig.

3) 1959년 Prinzmetal등1)이 안정시에 주기적으로 반 추적 관찰한 심초음파상 기저전벽, 중전 벽, 기저전측벽, 복적인 흉통을 호소하면서 심전도상에는 일시적인 ST 기저전중격에 새롭게 중등도의 저운동성이 관찰되었다.

Acetylcholine을 을 투여하기전 근위 좌전하행지의 ). 30-50%정도의 정도의 협착(RAO 40 협착 Fig. 2-B.

3 폐쇄되는 것을 볼 수 있었고(Fig. 2-B), 이때 흉통과 여 주기적으로 반복되던 자발적인 협심증상이 완전히 더불어 심전도 소견상 V2-6까지 ST분절의 상승이 관 소실되었으며 현재 외래 추적관찰중이다. 찰되었으며(Fig. 2-C) nitroglycerin 200μg을 관동 고 맥내 투여후 흉통은 사라졌으며 ST분절도 정상화되었 찰 다. 심근효소를 연속추적 관찰한 결과 상승은 없었으 며, 흉통이 없는 상태에서 심전도는 정상이었고(Fig. 3) 1959년 Prinzmetal등1)이 안정시에 주기적으로 반 추적 관찰한 심초음파상 기저전벽, 중전 벽, 기저전측벽, 복적인 흉통을 호소하면서 심전도상에는 일시적인 ST 기저전중격에 새롭게 중등도의 저운동성이 관찰되었다. 절의 상승을 나타내는 이형 협심증을 보고하면서 이의 그후 환자는 nitrate와 calcium antagonist를 투여하 기전을 고정적인 유의한 협착이 있는 관동맥의 경련을 Fig. 2-A. Acetylcholine을 을 투여하기전 근위 좌전하행지의 ) %정도의 정도의 협착(RAO 40 협착 Fig. 2-B. Acetylcholine 40 microgram을 을 관동맥내 주사후 근위 좌전하행지의 연축으로 인한 그 이하부위의 완 전폐쇄. 전폐쇄. Fig. 2-C. 관동맥조영술 소견상 (a) base-line EKG, (b) acethylcholine 40μg을 을 관동맥내 관동맥내 주사후, 주사후 (c) nitroglycerine 200μg을 을 관동맥내에 주사후. 주사후. 561

4 Fig. 3. Beta-blocker 투여 3일후흉통이없는상태에서의심전도소견. 562

5 563

6 요약 References 1) Prinzmetal M, Kennamer R, Merliss R, et al:angina pectoris. 1. A variant form of angina pectoris, preliminary report. Am J Med 27: , ) Heupler FA Jr, Proudfit WL, Razavi M, Shirey EK, Greenstreet R, Sheldon WC:Ergonovine maleate provocation test for coronary arterial spasm. Am J Cardiol 41: , ) Schroede JS, Silverman JF and Harrison DC:Right coronary artery spasm causing Prinzmetal s variant angina. Chest 65:573, ) Oliva PB, Potts DE and Pluss RG:Coronary arterial spasm in Prinzmetal s angina:documentation by coronary arteriography. N Engl J Med 288:745, ) Ganz P and Alexander R W:New insights into the cellular mechanisms of vasospasm. Am J Cardiol 56:11E, ) 박영배 이영우 : 관상동맥경련에관한연구. 순환기 18:161, ) Epstein SE, Talbot TL:Dynamic coronary artery tone in precipitation, exacerbation and relief of angina pectoris. J Am Coll Cardiol 8:245, ) Hoshio A, Kotake H, Mashiba H:Significanceof coronary artery tone in patients with vasospastic angina. J Am Coll Cardiol 14:607, ) Willerson JT, Hillis LD, Winniford M, Buja LM:Speculation regarding mechanisms responsible for acute ischemic heart disease syndromes. J Am Coll Cardiol 8: 245, ) Maseri A, L Abbate A, Baroldi G, et al:coronary vasospasm as a possible cause of myocardial infarction. N Engl J Med 229:1271, ) Werns SW, Walto JA, Hsia HH, Nabel EG, Sanz ML, Pitt B:Evidence of endothelial dysfunction in angiographically normal coronary arteries of patients with coronary artery disease. Circulation 79:287, ) Gordon JB, Ganz P, Nabel EG, et al:atherosclerosis influences the vasomotor response of epicardial coronary arteries to exercise. J Clin Invest 83:1946, ) Cohen L and Kitzes R:Prompt termination and/or prevention of coldpressor-stimulus-induced vasocon-striction of different vascular beds by magnesium sulfate in patients with Prinzmetal s angina. Magnesium 5:144, ) Miyagi H, Yasue H, Okumura K, et al:effect of magnesium on anginal attack induced by hyperven-tilation in patientw with variant angina. Circulation 79:597, ) Kugiyama K, Yasue H, Okumura K:Suppression of exercise induced angina by magnesium sulfate in patients with variant angina. J Am Coll Cardiol 12:1177, ) Winniford MD, Jansin DE, Reynolds GA:Cigarette smoking induced coronary vasoconstriction in atherosclerotic coronary artery disease and prevention by calcium antagonists and nitroglycerin. Am J Cardiol 59: 203, ) Heupler FA Jr:Provocative testing for coronary arterial spasm:risk, method and rationale. Am J Cardiol 46: , ) Crevey BJ, Owen SF and Pitt B:Irreversible coronary occlusion related to administration of ergonovine. Circulation 64:853, ) Curry RC Jr, Pepine CJ, Varnell JH, Savom MB, Conti CR:Clinical usefulness and safety of the ergonovine test in patients with chest pain(abstr). Am J Cardiol 41: 369, ) Schroeder JS:Invasive Cardiology:Provocative tesiting for coronary artery spasm FA Davis Company, Philadelphia. 21) Braounwald E, Burton E Sobel:Coronary blood flow and myocardial ischemia, In Heart Disease. Braunwald E, 4th Ed. p , Philadepphia, WB Saunders Co,

7 22) Albert E, Raizner MD, Robert A, Chahine MD, Tetsuo Ishimori MD:Provocation of coronary artery spasm by the cold pressor test:circulation 62(5): , ) Shimizu H, Lee JD, Yamamoto M, Satake K:Induction of coronary artery spasm by combined cold pressor and hyperventilation test in patients with variant angina. Journal of Cardiology 24(4):257-61, 1994 Jul-Aug 24) Furchgott RF, Zawadzki JV:The obligatroy role of endothelial cells in the relaxation of arterial smooth muscle by acetylcholine. Nature 288: , ) Yasue H, Matsuyama K, Matsuyama K, Okumura K, Morikai U, Ogawa H:Responses of angiographically normal human coronary arteries to intracoronary infection of acetylcholine by age and segment. Circulation 81: , ) Okumura K, Yasue H, Matsuyama K:Sensitivity and specificity of intracoronary injection of acetylcholine for the induction of coronary artery spasm. J Am Coll Cardiol 12: , ) Matsuguchi T, Araki H, Anan T:Provocation of variant angina by alcohol ingestion. European H J 5(11):906-12, 1984 Nov 28) Robert Ginsburg, Michael R Bristow, N Kantrowitz:Histamine provocation of clinical coronary artery spasm: Implacations concerning pathogenesis of variant angina pectoris. Am Heart J 102:819, ) John D, Rutherford, Braunwald E:Chronic ischemic heart disease, In heart disease, Braunwald E, 4th Ed. p , Philadelphica, WB Saunders Co, ) SA Mortensen, R Vilhelmsen and E Sandoe:Non-pharmacological provocation of coronary vasospasm. Experience with prolonged hyperventilation in the coronary care unit. European H J 4(6): , 1983 Jun 565

of medication with calcium channel blocker or nitrate compared with those in previous studies. Korean Circulation J 1999;293: KEY WORDSVariant

of medication with calcium channel blocker or nitrate compared with those in previous studies. Korean Circulation J 1999;293: KEY WORDSVariant Original Articles Korean Circulation J 1999;293:276-284 급성심근경색증으로발현한변이형협심증환자의 임상적, 관동맥조영검사상특성및장기추적관찰 두영철 김재삼 채경수 송관욱 홍경순 박대균 한규록오동진 유규형 임종윤 고영박 이광학 이영 Clinical and Angiographic Characteristics and Long-term