血圧降下に伴い反復性，可逆性のST変化を呈した非定型的な心筋硬塞症の1例

A case of atypical myocardial infarction with reciprocal and reversible ST changes in hypotension

　心筋硬塞症の初期に血圧が低下するに伴いECGではST部分が上昇し，血圧を上げると，ST部分がもとに戻るということをくり返しながら後増硬塞の所見が完成されていった例を経験した。この血圧の変動を生じた原因と，それに伴うECGの変化について検討してみたい。

A 82 year old male developed the epigastric pain and hypotension suddenly. ECG showed the elevation of ST, T and R in L₂, ₃, _aV_F and also the depression of ST in _aVR and _aV_F. The blood pressure was 74 mmHg., and the complete atrioventricular block was ind-uced. After the injection of the vasoconstri-ctive substances the blood pressure was re-stored, and then the deviation of ST disapp-eared. These changes were repeated in five times in every about one hour. On the next day ECG showed the typical pattern of myo-cardial infarction in the posterior wall.

This reciprocal and reversible ST deviation would be explained as follows. Initially the coronary arteries were narrowed and the co-rollary blood flow was decreased. Then the coronary insufficiency was induced. The my-ocardium was injured and hypotension was caused. This decreased coronary flow cau-sed the ST deviation in this case.