Review Articles 27 5 1997 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
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. 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 ). 30-50%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
Fig. 3. Beta-blocker 투여 3일후흉통이없는상태에서의심전도소견. 562
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