Nisoldipine投与により胸痛発作の増悪を認めた冠攣縮性狭心症の1例

A Case of Vasospastic Angina with Worsening of Chest Pain associated with the Administration of Nisoldipine

　50歳，男性．主訴は安静時胸痛．1996年3月頃より安静時に胸痛が出現するようになり，近医で狭心症を疑われ精査加療目的で同年4月9日に当科へ入院した．4月12日に施行された心臓カテーテル検査で，冠動脈の有意な器質的狭窄を認めなかったが，アセチルコリン誘発試験にて3枝の有意なspasmを認め，多枝冠攣縮性狭心症と診断した．カルシウム拮抗薬（diltiazem），亜硝酸薬の併用療法により経過良好であったが，同年8月頃より再度，安静時胸痛が出現するようになった．1997年2月にnisoldipineを追加投与したが，その直後より安静時胸痛が頻発し，発作の増悪を認めたためnisoldipineを自己中止したところ発作は軽快した．nisoldipineが胸痛発作の増悪に関連していると考えられ，冠攣縮性狭心症の治療に際し，注意を余儀なくされた症例であり報告する．

　A 50-year-old male was admitted for examination of chest pain at rest. Coronary angiography (CAG)revealed organic stenosis of neither the anterior descending artery (LAD), the left circumflex artery (LCX) nor the right coronary artery (RCA). However, significant and severe spasm was observed in RCA, LAD and LCX during an acetylcholine provocation test. Because of this, he was diagnosed as having vasospastic angina involving these three vessels. He had been treated with calcium antagonist diltiazem and isosorbide dinitrate, and his symptoms had significantly improved. However, eight months later he again complained of chest pain at rest, and 10 mg per day of nisoldipine was added to his medication. After the administration of nisoldipine, marked worsening of his chest pain was observed. He suspected that nisoldipine was responsible for the worsening of his symptoms, and he stopped using this drug. After the cessation of nisoldipine, his chest symptoms improved significantly. In this patient, we surmise that the worsening of his chest pain was associated with the administration of nisoldipine, and coronary spasms were induced by this drug. The calcium antagonists may have induced coronary vasospasm in this case, though the exact cause of coronary spasm is unknown.