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Kokyu to Junkan Volume 38, Issue 8 （August 1990）

呼吸と循環 38巻8号（1990年8月発行）

Japanese English

症例

PTCA後のTreadmill運動負荷試験により生じた急性冠閉塞の2例 Two cases of acute coronary occlusion after successful coronary angioplasty associated with a treadmill stress testing 満尾和寿 ¹ , 出川敏行 ¹ , 当間三弘 ¹ , 中村茂 ¹ , 宇井克人 ¹ , 中村正人 ¹ , 吉村宏 ¹ , 渡部純郎 ¹ , 長谷弘記 ¹ , 二宮健次 ¹ , 矢吹壮 ¹ , 町井潔 ¹ Kazuhisa Mitsuo ¹ , Toshiyuki Degawa ¹ , Mitsuhiro Tohma ¹ , Shigeru Nakamura ¹ , Katsuto Ui ¹ , Masato Nakamura ¹ , Hiroshi Yoshimura ¹ , Sumio Watanabe ¹ , Hiroki Hase ¹ , Kenji Ninomiya ¹ , So Yabuki ¹ , Kiyoshi Machii ¹ ¹東邦大学医学部第三内科 ¹The Third Department of Internal Medicine, Toho University, School of Medicine キーワード：経皮的冠動脈形成術（percutaneous transluminal coronary angioplasty） , トレッドミル運動負荷試験（treadmill stress testing） , 急性冠閉塞（acute coronary occlusion） Keyword: 経皮的冠動脈形成術（percutaneous transluminal coronary angioplasty） , トレッドミル運動負荷試験（treadmill stress testing） , 急性冠閉塞（acute coronary occlusion） pp.805-810

発行日 1990年8月15日 Published Date 1990/8/15

DOI https://doi.org/10.11477/mf.1404900198

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Abstract 文献概要
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　トレッドミル運動負荷試験（以下トレッドミル試験）は虚血性心疾患の診断そして薬物治療，経皮的冠動脈形成術（以下PTCA）の効果判定に有用である。しかし，まれではあるが合併症が報告されており，我々はPTCA後のトレッドミル試験直後に，急性冠閉塞をきたした2症例を経験した。

　症例1：NT,54歳男性。右冠動脈と左回旋枝に対してPTCA実施後8病EIにmodified Bruceprotocolに従いsymptom-limited法にてトレッドミル試験を実施したが直後に右冠動脈に急性冠閉塞を認めた。症例2：YH,68歳男性。左前下行枝にPTCA実施後18病日に同protocolに従いトレッドミル試験を実施したが直後に右冠動脈に急性冠閉塞を認めた。いずれの症例においても再PTCAにより再拡張に成功した。

　運動耐容能の評価を目的としたPTCA後比較的早期のsymptom-limited法による高レベルのトレッドミル試験の実施は急性冠閉塞などの合併症の発生に留意すべきであると考えられた。

We presented two cases of acute coronary occlu-sion after successful percutaneous transluminal coro-nary angioplasty (PTCA) associated with a tread-mill stress testing.

Case 1: A 54-year-old man with effort angina was referred to our hospital for cardiac catheterization. At the time of cardiac catheterization, the proximal RCA had a 99% diameter narrowing, and the prox-imal LCX had a 90% diameter narrowing. PTCA was performed and both lesions were successfully dilated. Eight days after PTCA, he had a symptom-limited treadmill stress testing, using the Bruce protocol. The exercise was terminated at a peak heart rate of 173 min (103% of aged-predicted maximal heart rate), and at a maximal systolic blood pressure of 140 mmHg. A few minutes after the end of exer-cise, he developed a severe chest pain and ECG changes, which showed ST elevation in leads II, III, aVF and ST depression in leads V4-V5. Emergency coronary angiography disclosed an acute coronary occlusion of RCA at the site of PTCA. Emergency PTCA was performed and the lesion was successfully re-dilated.

Case 2: A 68-year-old man was referred to our hos-pital for cardiac catheterization a month after sub-endocardial anterior myocardial infarction. At thetime of cardiac catheterization, the proximal LAD have a 99% diameter narrowing. PTCA was perform-ed and the lesion was successfully dilated. 18 days after PTCA, he had a symptom-limited treadmill stress testing, using the Bruce protocol. The exercise was terminated at a peak heart rate of 158/min (102% of aged-predicted maximal heart rate), and at a maximal systolic blood pressure of 218 mmHg. Ten minutes after the one of 218 mmHg. Ten minutes after the end of exercise, he developed a severe chest pain and ECG changes, which showed ST elevation in leads III, III, aVF and ST depres-sion in leads V3-V5. Emergency coronary angiogra-phy disclosed an acute coronory occlusion of LAD at the site of PTCA. Emergency PTCA was performed and the lesion was successfully re-dilated.

In general, treadmill stress testing is frequently performed within several days after PTCA and con-sidered safe and beneficial to assess the result of the procedure. However, acute coronary occlusion after PTCA associated with treadmill stress testing has been showen to develop in these cases, so it seems that early high level exercise may be harmful.