鼠径ヘルニア術後に合併した冠攣縮性狭心症の1例
「はじめに」 冠攣縮性狭心症の予後は良好とされているが, 冠攣縮に伴って心臓突然死または失神を来す症例も少なくない. カルシウム拮抗薬内服下でも冠攣縮発作や心室細動(ventricular fibrillation: VF)を発症する場合もある. このような難治性の症例に対する治療について, 現時点では統一された見解がない. 今回, 我々は冠攣縮性狭心症に合併したVFに対して, 繰り返し直流電気除細動(direct current defibrillation: DC)を行うもVFの停止に至らず, 冠動脈への硝酸イソソルビド(isosorbide dinitrate: ISDN)を投与後にDC...
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| Published in | CIRCULATION CONTROL Vol. 35; no. 1; pp. 41 - 43 |
|---|---|
| Main Authors | , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本循環制御医学会
2014
Japan Society of Circulation Control in Medicine |
| Online Access | Get full text |
| ISSN | 0389-1844 |
| DOI | 10.11312/ccm.35.41 |
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| Abstract | 「はじめに」 冠攣縮性狭心症の予後は良好とされているが, 冠攣縮に伴って心臓突然死または失神を来す症例も少なくない. カルシウム拮抗薬内服下でも冠攣縮発作や心室細動(ventricular fibrillation: VF)を発症する場合もある. このような難治性の症例に対する治療について, 現時点では統一された見解がない. 今回, 我々は冠攣縮性狭心症に合併したVFに対して, 繰り返し直流電気除細動(direct current defibrillation: DC)を行うもVFの停止に至らず, 冠動脈への硝酸イソソルビド(isosorbide dinitrate: ISDN)を投与後にDCを施行して洞調律への復帰が可能であった一例を経験した. 症例 症例:62歳, 男性. 主訴:意識消失. 現病歴:7月に心房粗動(atrial flutter: AFL)に対してBepridil hydrochloride 200mg/日処方されたが, 薬剤性QT延長症候群で内服中止となっていた. |
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| AbstractList | We report a case of a 62-year-old Japanese man with ventricular fibrillation(VF) refractory to direct-current(DC) shocks accompanied by vasospastic angina pectoris(VSA). The patient was referred to our institute for radiofrequency catheter ablation of atrial fibrillation(AF) and developed coronary artery spasms in the distal right coronary artery(RCA) and distal left circumflex coronary artery immediately after performing the AF ablation, which were relieved via an intracoronary administration of isosorbide dinitrate. Thereafter, an oral calcium antagonist was effective in preventing the VSA. However, VF occurred after an inguinal hernia repair under general anesthesia and could not be terminated by repeated DC shocks. A percutaneous cardiopulmonary support(PCPS) system was instituted immediately under cardiopulmonary resuscitation. Emergency coronary angiography revealed a total occlusion of the ostial RCA. The persistent VF was at last successfully terminated with a DC shock which was performed after the occlusion of the RCA was relieved by the intracoronary administration of isosorbide dinitrate. The patient received an implantable cardioverter-defibrillator, oral nitrates and calcium antagonists. Coronary vasodilators might play an important role in the termination of VF refractory to repeated DC shocks in patients with VSA episodes. 「はじめに」 冠攣縮性狭心症の予後は良好とされているが, 冠攣縮に伴って心臓突然死または失神を来す症例も少なくない. カルシウム拮抗薬内服下でも冠攣縮発作や心室細動(ventricular fibrillation: VF)を発症する場合もある. このような難治性の症例に対する治療について, 現時点では統一された見解がない. 今回, 我々は冠攣縮性狭心症に合併したVFに対して, 繰り返し直流電気除細動(direct current defibrillation: DC)を行うもVFの停止に至らず, 冠動脈への硝酸イソソルビド(isosorbide dinitrate: ISDN)を投与後にDCを施行して洞調律への復帰が可能であった一例を経験した. 症例 症例:62歳, 男性. 主訴:意識消失. 現病歴:7月に心房粗動(atrial flutter: AFL)に対してBepridil hydrochloride 200mg/日処方されたが, 薬剤性QT延長症候群で内服中止となっていた. |
| Author | 内藤, 滋人 河口, 廉 岡田, 修一 金子, 達夫 江連, 雅彦 中村, 紘規 長谷川, 豊 大島, 茂 佐藤, 泰史 |
| Author_FL | Ezure Masahiko Kawaguchi Ren Okada Shuichi Nakamura Koki Sato Yasushi Hasegawa Yutaka Naito Shigeto Kaneko Tatsuo Oshima Shigeru |
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| DocumentTitleAlternate | Occurrence of Ventricular Fibrillation Refractory to Direct Current Shocks in a Patient with Vasospastic Angina Pectoris |
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| References | 佐々木俊雄, 榊原雅義, 青柳秀史, 他: ステント留置術後に，び漫性多枝冠攣縮をきたし心原性ショックとなった1例. Jpn J Interv Cardiol 2001; 16: 52-6. Rozanski A, Berman DS: Silent myocardial ischemia. 1. Pathophysiology, frequency of occurrence, and approaches toward detection. Am Heart J 2003; 114: 594-9. Takeda Y, Yasuga Y, Sasako Y, et al: Perioperative multivessel coronary vasospasm as a cause of cardiogenic shock immediately after off-pump coronary artery bypass grafting surgery: a case report. J Cardiol 2005; 45: 61-8. Suematsu M, Ito Y, Fukuzaki H: The role of parasympathetic nerve activity in the pathogenesis of coronary spasm. Jpn Heart J 1987; 28: 649-61. 木皿晶子, 柳下芳寛, 荘念 仁: NTGおよびDTZの予防的投与にもかかわらず, 術中に冠動脈れん縮をきたした血管れん縮性狭心症の一例. 日本臨床麻酔学会誌 1996; 16: 604-7. Meisel SR, Mazur A, Chetboun I: Usefulness of implantable cardioverter-defibrillators in refractory variant angina pectoris complicated by ventricular fibrillation in patients with angiographically normal coronary arteries. Am J Cardiol 2002; 89: 1114-6. Okuda T, Wakita T: Recurrent coronary artery spasm during a non-cardiac surgical procedure. J Anesth 1992; 6: 503-6. Rasmussen K, Henningsen P: Provocative testing with prolonged hyperventilation and ergometrine in patients suspected of coronary artery spasm: a comparative study. Int J Cardiol 1987; 15: 151-63. Koshiba K, Hoka S: Clinical characteristics of perioperative coronary spasm: reviews of 115 cases reports in Japan. J Anesth 2001; 15: 93-9. |
| References_xml | – reference: Okuda T, Wakita T: Recurrent coronary artery spasm during a non-cardiac surgical procedure. J Anesth 1992; 6: 503-6. – reference: Rozanski A, Berman DS: Silent myocardial ischemia. 1. Pathophysiology, frequency of occurrence, and approaches toward detection. Am Heart J 2003; 114: 594-9. – reference: Suematsu M, Ito Y, Fukuzaki H: The role of parasympathetic nerve activity in the pathogenesis of coronary spasm. Jpn Heart J 1987; 28: 649-61. – reference: Meisel SR, Mazur A, Chetboun I: Usefulness of implantable cardioverter-defibrillators in refractory variant angina pectoris complicated by ventricular fibrillation in patients with angiographically normal coronary arteries. Am J Cardiol 2002; 89: 1114-6. – reference: Koshiba K, Hoka S: Clinical characteristics of perioperative coronary spasm: reviews of 115 cases reports in Japan. J Anesth 2001; 15: 93-9. – reference: Rasmussen K, Henningsen P: Provocative testing with prolonged hyperventilation and ergometrine in patients suspected of coronary artery spasm: a comparative study. Int J Cardiol 1987; 15: 151-63. – reference: 佐々木俊雄, 榊原雅義, 青柳秀史, 他: ステント留置術後に，び漫性多枝冠攣縮をきたし心原性ショックとなった1例. Jpn J Interv Cardiol 2001; 16: 52-6. – reference: Takeda Y, Yasuga Y, Sasako Y, et al: Perioperative multivessel coronary vasospasm as a cause of cardiogenic shock immediately after off-pump coronary artery bypass grafting surgery: a case report. J Cardiol 2005; 45: 61-8. – reference: 木皿晶子, 柳下芳寛, 荘念 仁: NTGおよびDTZの予防的投与にもかかわらず, 術中に冠動脈れん縮をきたした血管れん縮性狭心症の一例. 日本臨床麻酔学会誌 1996; 16: 604-7. |
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| Snippet | 「はじめに」 冠攣縮性狭心症の予後は良好とされているが, 冠攣縮に伴って心臓突然死または失神を来す症例も少なくない. カルシウム拮抗薬内服下でも冠攣縮発作や心室細... We report a case of a 62-year-old Japanese man with ventricular fibrillation(VF) refractory to direct-current(DC) shocks accompanied by vasospastic angina... |
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| Title | 鼠径ヘルニア術後に合併した冠攣縮性狭心症の1例 |
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