精神的ストレスにより誘発されたと思われる冠攣縮性狭心症の2例

Two cases of vasospastic angina induced by psychotic stress

　冠動脈は自律神経系および体液性の調節により，そのトーヌスを保っているが，冠動脈攣縮の発生機序として，この制御機構の何らかの原因による破綻の可能性が考えられる。自律神経系が精神的ストレスと密接に関係している事実を考えれば，当然冠攣縮の誘因としてのストレスの存在が注目される。

　今回われわれは精神的ストレスが誘因となったと思われる冠攣縮性狭心症2例につき報告する。

We report two cases of vasospastic angina whose attacks were induced by psychotic stress and confirmed to be due to myocardial ischemia by monitoring ECG and coronary angiogram.

A 46-year-old woman (case 1) had begun to expe-rience chest pain during emotional distress (troubled marital problem) one year previously. She showed ischemic S-T segment depression with tall T wave at the time of the attack. Treadmill exercise test provo-cated anginal attack showing marked ischemic S-T segment depression. Sublingual administration of nitro-glycerine relieved chest pain and improved S-T segment depression within 3 minutes. A selective left coronary angiogram showed obstruction (75%) at the proximal portion of LAD. After sublingual administration of nitroglycerine, a left coronary angiogram showed no obstruction, and we assumed that the obstruction had been due to spasm of LAD.

A 33-year-old woman (case 2) admitted our clinic, complaining of dyspnea with anterior precordial dist-ress and was diagnosed as the hyperventilation syndrome with coronary artery disease. She also had a troubled marital problem. The ECG on admission revealved ischemic S-T segment depression. Treadmill exercise test was positive, showing S-T segment depression. A selective left coronary angiogram showed 50% stenosis at the proximal portion of LAD. After sublingual administration of nitroglycerine, the proximal portion of LAD was almost normal visualization.

In both of them, no anginal attack occured after resolution of their existing problems and treadmill exercise test became negative.

From these findings, we concluded that the psychotic stress provocated coronary vasospasm and it could play a great important part as an initiating factor of myo-cardial ischemia.