甲状腺機能亢進症を伴う冠攣縮性狭心症の2例

Vasospastic Angina Associated with Hyperthyroidism:Report of two cases

　症例1：66歳，男性．不安定狭心症．発作時心電図でII,III,aV_FのST上昇を認めた．発作時の冠動脈造影では右冠動脈の完全閉塞・左前下行枝の50％狭窄を認めた．Nitrog—lycerine投与後には25％狭窄のみであった．甲状腺ホルモンの著明な上昇を認め，Thiam—azoleの投与を開始した．発作は2週間で消失した．症例2：75歳，男性．安静時狭心症．発作時心電図でI,II,aV_F,V₃〜V₆のST低下を認めた．甲状腺ホルモンの著明な上昇を認め，Thiamazoleの投与を開始した．発作は1週間で消失した．冠動脈造影では有意狭窄はなく，壁不整を認めるのみであった．

　2症例の特徴は，①冠攣縮性狭心症であり，抗甲状腺剤の投与開始とともに発作が改善した，②著明な体重減少が主症状であった，の2点であった．したがって安静時狭心症を主訴とし，著明な体重減少を伴う症例では甲状腺機能亢進症の合併を疑うことが重要と考えられた．

We report two patients with vasospastic angina as-sociated with hyperthyroidism. Case 1.A 66-year-old man was admitted with unstable angina pectoris and weight loss. An electrocardiogram (ECG) during an-ginal attack showed ST-segment elevation in leads II, III, aV_F. Coronary arteriography demonstrated total occlusion of the right coronary artery and 50% luminal diameter reduction of the left anterior descending coro-nary artery. Isosorbide dinitrate administered intracor-onarily reduced the stenosis to 25% luminal reduction of both coronary arteries. Serum hormonal examination revealed elevated thyroid hormones. After treatment with thiamazole, angina attacks disappeared.

Case 2. A 75-year-old man was admitted with rest angina associated with weight loss. During anginal attack an ECG showed ST-segment depression in leads I, II, aV_F, and V₃~V₆.Diagnosis of hyperthyroidism was made from consideration of elevated serum thyroid hormone levels. Anginal attacks disappeared after thiamazole administration. No significant coronary artery stenosis was observed on coronary arteriogra-phy.

These cases showed the following characteristics : 1) disappearance of anginal attacks after anti-hyperthyr-oid agent administration ; 2) association with marked weight loss.