発作時にくしゃみを伴った異型狭心症の1例

A Case of Variant Angina Associated with Sneeze

　症例は47歳，男性．1995年4月22日午前7時頃，くしゃみをした直後に前胸部圧迫感が出現した．痛みは約15分続いた．さらに，同年5月16日午前7時頃，くしゃみをした直後に前胸部圧迫感が生じた．その際，便意も催し，排便後に失神したが，意識は10分弱で同復し，胸痛も消失した．近医の紹介により同年5月29日に当院に入院した．6月1日に冠動脈造影検査を施行，コントロール造影では両側冠動脈に器質的狭窄を認めなかったためアセチルコリン冠攣縮誘発試験を行った．その結果，右冠動脈，および左回旋枝は完全閉塞し，それに伴って胸部圧迫感と心電図上ST上昇を認めた．以上より異型狭心症と診断した．以後，抗狭心症薬の投与により狭心症発作は一度も起きていない．本症例は狭心症発作の前駆症状にくしゃみを認めた稀な症例である．

We report a case of variant angina associated with sneezing preceding chest pain. A 47 year-old man noticed two episodes of chest oppression which occurred just after sneezing in the early hours of the morning and which lasted for ten minutes or more. He also experi-enced syncope during one of those two attacks. On the 4th hospital day. our patient underwent coronary angio-graphy. In the control state, no Organic luminal narrow-ing was found in the three major coronary arteries, right coronary artery (RCA). left anterior descending coro-nary artery and left circumflex coronary artery (LCX), so acetylcholine (ACh) provocation test for coronary vasospasm was performed. First, 20μg of ACh was injected into the RCA, and the RCA occluded totally at the middle through to the distal portion. Secondly, 20μg of ACh was injected into the left coronary artery. and total occlusion developed at the middle portion of the LCX. While severe vasoconstriction occurred in the RCA or LCX. both chest oppression and ST-segment elevation in the electrocardiogram were found without relation to sneezing. After administration of 2.5mg of isosorbide dinitrate, severe vasoconstriction disappear-ed. Therefore, he was diagnosed as having vasospastic angina. After treatment with 5mg/day of nisoldipine and 25mg/day of nitroglycerin, he experienced no more anginal attacks.