夜間狭心症の冠動脈攣縮について

Coronary spasm in nocturnal angina

　冠動脈攣縮の機序については，多くの検討がなされている。今回私達は夜半から早朝にかけての睡眠時にST上昇の発作を起す狭心症の1例を経験し，その攣縮機序について詳細に検討したので報告する。

A 47-year-old male with spontaneous chest oppression and essential hypertension was ad-mitted. The attack during sleeping at midnight had ST elevation on _aA_F without alteration in heart rate and the symptom after loading of exercise or defecating had ST depression with tachycardia. EEG usually showed several times of REM stage from midnight to early morning and ST depression on II, III and _a V_F 30 minutes after one REM at 4: 22 AM. Cardiac catheteri-zation showed no cardiac hypofunction. Coronary angiography demonstrated organic stenosis of over 75% on the No. 6 of LAD and strictly smooth narrowing on the No. 2 of RCA during the spontaneous attack, but expanded one with slight narrowing after administration with nitro-glycerin on the No. 2 of RCA. The LAD was bypassed with graft of saphenous vein from the patients own leg and the RCA was extended with patch by vertical cutting because of the atherosclerotic narrowing with a few cm smooth width. The course after the operation is well.