労作性狭心症から排尿狭心症へ移行した女性例

Transition of effort angina to micturition angina in a female case

　排尿狭心症（micturition angina）の最初の記載は，約300年前にさかのぼる_1）。しかし，その後の症例報告はMorris and McIntosh_2），およびMarriot and Vogt_3）らによって僅か数例なされているに過ぎず，この機序等の詳細はまだ明らかにされていない。本疾患のこれまでの報告は，いずれも男性例であったが，最近我々は労作時狭心症を有する女性が排尿に伴って狭心症を呈するようになった症例を経験したので報告する。

A female case of micturition angina is reported. The patient was a 67-year-old female with the chief complaint of chest pain after voiding. She had expe-rienced angina on effort 3 years ago for the first time and chest pain soon after voiding occurred 2 months prior to admission. Frequency of micturition angina increased gradually but anginal attacks were not induced by daily exercise. Attacks usually occurred in midnight or early morning about 30 seconds to 3 minutes after voiding with the duration of 30 seconds to minutes. ST-T changes in ECG during attacks indicated ischemic myocardial damage. Master's two step test also indicated ischcmic myocardial damage on exercise even when angina was not accompanied. Nitroglycerin or isosorbide dinitrate and calcium antagonist effectively suppressed micturition angina. The mechanism of the micturition angina was con-sidered to be myocardial ischemia brought about not only by the atherosclerotic changes of the coronary arteries but also by the coronary vasospasm induced by vagovagal reflex associated with voiding.