運動負荷試験後に発症した，出血性心筋梗塞症と考えられる1剖検例

Acute hemorrhagic myocardial infarction following treadmill exercise test

　Treadmill多段階運動負荷試験が虚血性心疾患の診断，治療効果あるいは予後の判定などに広く用いられるようになるにつれて，その安全性や合併症についても注目されてきている。

　最近われわれは，Treadmill負荷試験終了後まもなく急性心筋梗塞症（以下AMI）をおこし，剖検により，梗塞巣内に広汎な出血の認められた1例を経験したので報告する。

A patient with acute hemorrhagic infarction of myocardium which occured after treadmill exercise test is presented in this report. The patient was a 52 year-old male, who had antero-septal myocardial infarction five years ago. Since then he often had episodes of chest oppression and shortness of breath with his mild effort. On February 13, 1979, he consulted the NationalCardiovascular Center and was prescribed for isosorbide dinitrate and digoxin. He had had no anginal attacks for the last one month, until he had treadmill exercise test for the evaluation of his exercise tolerance. Exercise was terminated because of his chest pain, but no ischemic ST changes were observed. Fifty minutes after the exercise test, he had severe chest pain and acute myocardial infarction was diagnosed because of ST elevation in leads I, aVL, and V 2-6 on ECG. He was admitted to the coronary care unit and six days later he died of severe congestive heart failure.

Fresh infarcted myocardium with massive hemorrhage in the anterior wall of the left ven-tricle and interventricular septum, as well as scared myocardium in the inferior wall were revealed at autopsy. Hemorrhage and fresh thrombi were found in the atheromatous plaqueof the left and right coronary arteries, indicating the possibility that the onset of myocardial infarction is precipitated by intimal hemorrhage which is brought by increased intracapillary pressure induced by vigorous physical exercise, as hypothesized by Paterson.