Case Reports Korean Circulation J 2000;3011:1455-1459 대동맥벽내혈종환자에서베타차단제사용후 이형협심증에인한심근경색증 1 예 김중선 김병극 고영국 한승혁 서혜선 최동훈 조승연 A Case of Myocardial Infarction Caused by a Variant Angina during Treatment with -blocker of Intramural Hematoma Jung Sun Kim, MD, Byeong Keuk Kim, MD, Young Kuk Ko, MD, Seung Hyeok Han, MD Hye Sun Soe, MD, Donghoon Choi, MD and Seung Yeon Cho, MD 1 Cardiology Division, Yonsei Cardiovascular Hospital, Yonsei Cardiovascular Research Institute, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea ABSTRACT Variant angina is characterized by repeated attack at rest associated with ST-segment elevation on ECG and caused by the spasm of coronary artery. But, the pathogenesis of spasm is not well known. A 44-year old man was transferred for the management of intramural hematoma at descending thoracic aorta and uncontrolled hypertension. We Sstarted to control hypertension with nitroprusside, propranolol, amlodipine, and doxazocin. At 4th hospital day, severe chest pain, dizziness, and diaphoresis were developed, and ECG showed not only STsegment elevation on lead II, III, avf but also 2AV block Mobitz type II. CK-MB revealed 52.3 ng/dl. When coronary angiography performed emergently, it showed total occlusion of right coronary artery RCA and diffuse minimal narrowing of left anterior descending coronary artery LAD. After nitroglycerin was infused via right coronary catheter, the RCA was opened completely, and reperfusion arrhythmia was developed. Medication were changed to nifedipine, diltiazem, nicorandil, isosorbide mononitrate and he had no more chest pain. Korean Circulation J 2000;3011:1455-1459 KEY WORDSVariant angina Intramural hematoma -blocker. 서 론 1455
증례 Fig. 1. Computed tomography scan with contrast enhancement demonstrated intramural hematoma extending from aortic arch to thoracic descending aorta. 1456 Korean Circulation J 2000;3011:1455-1459
혈종이 두께 1.2 cm, 총 길이는 23 cm, 최장 대동맥 직 상 Ⅱ, Ⅲ, avf에 ST분절의 상승 소견있어 nitroglycerin 경 4 cm으로 발견되어(Fig. 1) nitroprusside 정맥내 주 투여 후 호전되었다가 다시 수축기 혈압 90 mmhg까지 입, propranolol 240 mg, amlodipine 10mg, doxazo- 떨어지는 소견과 심전도상 Ⅱ, Ⅲ, avf에 ST분절의 상 cin 4 mg으로 치료를 시작하였다. 승 소견과 2도 방실 결절 차단(Morbitz type II)이 나 내원 4일째 발한을 동반한 흉통을 호소하면서 심전도 A B Fig. 2. Electrocardigraphy showed initial (A), marked ST segment at II, III, avf after chest pain developed (B) and Isoelectrical sinus rhythm after chest pain subsided (C). C A B Before NTG infusion C 타나면서 심근 효소 검사상 CK-MB 52.34 ng/dl의 상 After NTG infusion Before NTG infusion After NTG infusion Fig. 3. Coronary angiography. A Left coronary angiogram revealed the resolution of diffuse luminal narrowing after nitroglycerin. B Right coronary angiogram revealed the resolution of total occlusion after nitroglycerin via intracoronary artery. C Reperfusion arrythmia developed iust after the resolution of coronary spasm. 1457
고찰 1458 Korean Circulation J 2000;3011:1455-1459
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