대동맥 벽내 혈종환자에서 베타 차단제 사용 후 이형 협심증에 인한 심근 경색증 1예

Abstract

Variant angina is characterized by repeated attack at rest associated with ST-segment elevation on ECG and caused by the spasm of coronary artery. But, the pathogenesis of spasm is not well known. A 44-year old man was transferred for the management of intramural hematoma at descending thoracic aorta and uncontrolled hypertension. We Sstarted to control hypertension with nitroprusside, propranolol, amlodipine, and doxazocin. At 4th hospital day, severe chest pain, dizziness, and diaphoresis were developed, and ECG showed not only STsegment elevation on lead II, III, aVF but also 2°AV block (Mobitz type II). CK-MB revealed 52.3 ng/dl. When coronary angiography performed emergently, it showed total occlusion of right coronary artery (RCA) and diffuse minimal narrowing of left anterior descending coronary artery (LAD). After nitroglycerin was infused via right coronary catheter, the RCA was opened completely, and reperfusion arrhythmia was developed. Medication were changed to nifedipine, diltiazem, nicorandil, isosorbide mononitrate and he had no more chest pain. (Korean Circulation J 000;30(11):1455-1459)