1日の怠薬により心室細動を発症した冠攣縮性狭心症の1例
症例は53歳男性. 平成26年2月に早朝の胸痛を自覚し, 急性冠症候群疑いで冠動脈造影 (CAG) を施行. 有意狭窄を認めず, 病歴上, 冠攣縮性狭心症 (VSA) が疑われた. 心電図では側壁誘導でJ波を認め, T Wave Alternans (TWA) も陽性であった. 同年4月にアセチルコリン負荷試験目的で入院, 負荷前の造影ですでに3枝spasmを認め, 非持続性多形性心室頻拍が出現した. 同時に胸痛, ST上昇も認めVSAと診断した. 退院後1カ月にて, 服薬を忘れた翌朝に胸痛を伴い心室細動 (VF) が出現. 救急車内のAEDではVFは停止せず直近の病院に搬送後, 除細動にて洞...
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| Published in | Shinzo Vol. 47; no. SUPPL.1; pp. S1_79 - S1_86 |
|---|---|
| Main Authors | , , , , , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
公益財団法人 日本心臓財団
2015
Japan Heart Foundation |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0586-4488 2186-3016 |
| DOI | 10.11281/shinzo.47.S1_79 |
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| Abstract | 症例は53歳男性. 平成26年2月に早朝の胸痛を自覚し, 急性冠症候群疑いで冠動脈造影 (CAG) を施行. 有意狭窄を認めず, 病歴上, 冠攣縮性狭心症 (VSA) が疑われた. 心電図では側壁誘導でJ波を認め, T Wave Alternans (TWA) も陽性であった. 同年4月にアセチルコリン負荷試験目的で入院, 負荷前の造影ですでに3枝spasmを認め, 非持続性多形性心室頻拍が出現した. 同時に胸痛, ST上昇も認めVSAと診断した. 退院後1カ月にて, 服薬を忘れた翌朝に胸痛を伴い心室細動 (VF) が出現. 救急車内のAEDではVFは停止せず直近の病院に搬送後, 除細動にて洞調律に復した. 同施設でのCAGにてもspasmを認めた. 当院転院後, 内服投与下でアセチルコリン負荷試験を施行したところ, 右冠動脈の99% spasmが誘発された. spasm解除後, 硝酸薬静注下の電気生理学的検査にて再現性を持ってVFが誘発された. 以上, 薬剤抵抗性のVSAにVFを合併し, Arrythmogenic substrate (不整脈原性基質) の存在を示唆する症例を経験したので報告する. |
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| AbstractList | 症例は53歳男性. 平成26年2月に早朝の胸痛を自覚し, 急性冠症候群疑いで冠動脈造影 (CAG) を施行. 有意狭窄を認めず, 病歴上, 冠攣縮性狭心症 (VSA) が疑われた. 心電図では側壁誘導でJ波を認め, T Wave Alternans (TWA) も陽性であった. 同年4月にアセチルコリン負荷試験目的で入院, 負荷前の造影ですでに3枝spasmを認め, 非持続性多形性心室頻拍が出現した. 同時に胸痛, ST上昇も認めVSAと診断した. 退院後1カ月にて, 服薬を忘れた翌朝に胸痛を伴い心室細動 (VF) が出現. 救急車内のAEDではVFは停止せず直近の病院に搬送後, 除細動にて洞調律に復した. 同施設でのCAGにてもspasmを認めた. 当院転院後, 内服投与下でアセチルコリン負荷試験を施行したところ, 右冠動脈の99% spasmが誘発された. spasm解除後, 硝酸薬静注下の電気生理学的検査にて再現性を持ってVFが誘発された. 以上, 薬剤抵抗性のVSAにVFを合併し, Arrythmogenic substrate (不整脈原性基質) の存在を示唆する症例を経験したので報告する. |
| Author | 島田, 博史 横山, 泰廣 増田, 怜 羽田, 泰晃 高宮, 智正 飯谷, 宗弘 李, 基鎬 中野, 国晃 山分, 規義 清水, 雅人 西﨑, 光弘 山添, 正博 西裕, 太郎 平岡, 昌和 中村, 玲奈 櫻田, 春水 稲村, 幸洋 藤井, 洋之 |
| Author_FL | Yamawake Noriyoshi Yokoyama Yasuhiro Hiraoka Masayasu Sakurada Harumizu Inamura Yukihiro Iiya Munehiro Shimada Hiroshi Masuda Ryo Shimizu Masato Nishi Yutaro Fujii Hiroyuki Nakamura Rena Yamazoe Masahiro Nishizaki Mitsuhiro Lee Kikou Hada Yasuaki Nakano Kuniaki Takamiya Tomomasa |
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| References | 15) Shimada H, Nishizaki, Fujii H, et al : Ambulatory Electrocardiogram-Based T-wave Alternans in Patients with Vasospastic Angina during Asymptomatic Periods. Am J Cardiol 2012 ; 110 : 1446-1451 4) Chevalier P, Dacosta A, Defaye P. et al : Arrhythmic cardiac arrest due to isolated coronary spasm : Long term outcome of seven resuscitated patients. J Am Coll Cardiol. 1998 ; 31 : 57-61 10) Suzuki M, Nishizaki M, Arita M, et al : Increased QT dispersion in patients with vasospastic angina. Circulation 1998 ; 98 : 435-440 13) Verrier RL, Klingenheben T, Malik M, et al : Microvolt T-wave alternans Physiological basis, methods of measurement, and clinical utility—Consensus Guideline by International Society for Holter and Noninvasive Electrocardiology. J Am Coll Cardiol 2011 ; 58 : 1309-1324 11) Nearing BD, Verrier RL : Modified moving average analysis of T-wave alternans to predict ventricular fibrillation with high accuracy. J Appl Physiol 2002 ; 92 : 541-549 3) Myerbrug RJ, Kessler KM, Mallon SM, et al : Life-threatening ventricular arrhythmias in patients with silent myocardial ischemia due to coronary artery spasm. N Engl J Med 1992 ; 326 : 1451-1455 8) Oh CM, Oh J, Shin DH, et al : Early repolarization pattern predicts cardiac death and fatal arrhythmia in patients with vasospastic angina. Int J Cardiol 2013 ; 167 : 1181-1187 5) Takagi Y, Yasuda S, Takahashi J, et al : Importance of dual induction tests for coronary vasospasm and ventricular fibrillation in patients surviving out-of-hospital cardiac arrest. Circulation Journal 2009 ; 73 : 767-769 17) Nishizaki M : Diagnosis, prediction and treatment of sudden cardiac death in patients with vasospastic angina. Shinzo 2014 ; 46 : 5-13 12) Verrier RL, Nearing BD, La Rovere MT, et al : Ambulatory electrocardiogram-based tracking of T wave alternans in postmyocardial infarction patients to assess risk of cardiac arrest or arrhythmic death. J Cardiovasc Electrophysiol 2003 ; 14 : 705-711 16) Jastrezebki M, Kukla P. Ischemic J wave : Noble risk marker for ventricular fibrillation? Heart Rhythm 2009 ; 6 : 829-835 7) Sato A, Tanabe Y, Chinushi M, et al. : Analysis of J waves during myocardial ischemia. Europace 2011 ; 14 : 715-723 2) Yasue H, Takizawa A, Nagano M, et al : Long-term prognosis for patients with variant angina and influential factors. Circulation 1988 ; 78 : 1-9 6) Nishizaki M, Arita M, Sakurada H, et al : Polymorphic ventricular tachycardia in patients with vasospastic angina--clinical and electrocardiographic characteristics and long-term outcome. Jpn Circ J 2001 ; 65 : 519-525 1) Miller DD, Waters DD, Szlachcic J, Theroux P : Clinical characteristics associated with sudden death in patients with variant angina. Circulation 1982 ; 66 : 588-592 9) Nishizaki M, Arita M, Sakurada H, et al : Induction of polymorphic ventricular tアセチルコリンycardia by programmed ventricular stimulation in vasospastic angina pectoris. Am J Cardiol 1996 ; 77 : 355-360 14) Maeda S, Nishizaki M, Yamawake N, et al : Abbulatory electrocardiogram-based T-wave alternanas and heart rate turbulence predict high risk of arrhythmic events in patients with old myocardial infarction. Circ J 2009 ; 73 : 2223-2228 18) Matsue Y, Suzuki M, Nishizaki M, et al : Clinical implication of an implantable cardioverter-defibrillator in patients with vasospastic angina and lethal ventricular arrhythmias. J Am Coll Cardiol. 2012 ; 60 : 908-913 |
| References_xml | – reference: 6) Nishizaki M, Arita M, Sakurada H, et al : Polymorphic ventricular tachycardia in patients with vasospastic angina--clinical and electrocardiographic characteristics and long-term outcome. Jpn Circ J 2001 ; 65 : 519-525 – reference: 16) Jastrezebki M, Kukla P. Ischemic J wave : Noble risk marker for ventricular fibrillation? Heart Rhythm 2009 ; 6 : 829-835 – reference: 12) Verrier RL, Nearing BD, La Rovere MT, et al : Ambulatory electrocardiogram-based tracking of T wave alternans in postmyocardial infarction patients to assess risk of cardiac arrest or arrhythmic death. J Cardiovasc Electrophysiol 2003 ; 14 : 705-711 – reference: 1) Miller DD, Waters DD, Szlachcic J, Theroux P : Clinical characteristics associated with sudden death in patients with variant angina. Circulation 1982 ; 66 : 588-592 – reference: 3) Myerbrug RJ, Kessler KM, Mallon SM, et al : Life-threatening ventricular arrhythmias in patients with silent myocardial ischemia due to coronary artery spasm. N Engl J Med 1992 ; 326 : 1451-1455 – reference: 5) Takagi Y, Yasuda S, Takahashi J, et al : Importance of dual induction tests for coronary vasospasm and ventricular fibrillation in patients surviving out-of-hospital cardiac arrest. Circulation Journal 2009 ; 73 : 767-769 – reference: 10) Suzuki M, Nishizaki M, Arita M, et al : Increased QT dispersion in patients with vasospastic angina. Circulation 1998 ; 98 : 435-440 – reference: 8) Oh CM, Oh J, Shin DH, et al : Early repolarization pattern predicts cardiac death and fatal arrhythmia in patients with vasospastic angina. Int J Cardiol 2013 ; 167 : 1181-1187 – reference: 13) Verrier RL, Klingenheben T, Malik M, et al : Microvolt T-wave alternans Physiological basis, methods of measurement, and clinical utility—Consensus Guideline by International Society for Holter and Noninvasive Electrocardiology. J Am Coll Cardiol 2011 ; 58 : 1309-1324 – reference: 17) Nishizaki M : Diagnosis, prediction and treatment of sudden cardiac death in patients with vasospastic angina. Shinzo 2014 ; 46 : 5-13 – reference: 18) Matsue Y, Suzuki M, Nishizaki M, et al : Clinical implication of an implantable cardioverter-defibrillator in patients with vasospastic angina and lethal ventricular arrhythmias. J Am Coll Cardiol. 2012 ; 60 : 908-913 – reference: 14) Maeda S, Nishizaki M, Yamawake N, et al : Abbulatory electrocardiogram-based T-wave alternanas and heart rate turbulence predict high risk of arrhythmic events in patients with old myocardial infarction. Circ J 2009 ; 73 : 2223-2228 – reference: 2) Yasue H, Takizawa A, Nagano M, et al : Long-term prognosis for patients with variant angina and influential factors. Circulation 1988 ; 78 : 1-9 – reference: 15) Shimada H, Nishizaki, Fujii H, et al : Ambulatory Electrocardiogram-Based T-wave Alternans in Patients with Vasospastic Angina during Asymptomatic Periods. Am J Cardiol 2012 ; 110 : 1446-1451 – reference: 9) Nishizaki M, Arita M, Sakurada H, et al : Induction of polymorphic ventricular tアセチルコリンycardia by programmed ventricular stimulation in vasospastic angina pectoris. Am J Cardiol 1996 ; 77 : 355-360 – reference: 11) Nearing BD, Verrier RL : Modified moving average analysis of T-wave alternans to predict ventricular fibrillation with high accuracy. J Appl Physiol 2002 ; 92 : 541-549 – reference: 4) Chevalier P, Dacosta A, Defaye P. et al : Arrhythmic cardiac arrest due to isolated coronary spasm : Long term outcome of seven resuscitated patients. J Am Coll Cardiol. 1998 ; 31 : 57-61 – reference: 7) Sato A, Tanabe Y, Chinushi M, et al. : Analysis of J waves during myocardial ischemia. Europace 2011 ; 14 : 715-723 |
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| Snippet | 症例は53歳男性. 平成26年2月に早朝の胸痛を自覚し, 急性冠症候群疑いで冠動脈造影 (CAG) を施行. 有意狭窄を認めず, 病歴上, 冠攣縮性狭心症 (VSA) が疑われた. 心電... |
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| SubjectTerms | J波 TWA 冠攣縮性狭心症 心室細動 怠薬 |
| Title | 1日の怠薬により心室細動を発症した冠攣縮性狭心症の1例 |
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