伟大的伪装者:血管紧张性心痛模仿左侧主要冠状动脉疾病
Maja Wojtylak1,2, Katarzyna Frączek1,2, Aleksander Zeliaś3,4
1Center for Innovative Medical Education, Jagiellonian University Medical College, Medyczna 7, 30-688 Kraków, Poland.
Journal of clinical medicine
|March 14, 2026
概括
患有胸痛且没有阻塞性冠状动脉疾病的患者通常患有冠状动脉微血管功能障碍和血管缩性胸痛. 侵入性功能测试对于诊断这些疾病和指导治疗至关重要.
科学领域:
- 心脏病学 心脏病学
- 血管医学 血管医学
- 诊断成像 诊断成像 诊断成像
背景情况:
- 许多心痛患者缺乏阻塞性冠状动脉疾病 (CAD).
- 冠状动脉微血管功能障碍 (CMD) 和血管痛 (VSA) 是这些患者的主要原因.
- 准确的诊断对于有效的治疗和预后至关重要.
研究的目的:
- 介绍一个案例,说明侵入性功能测试在患有非阻塞性冠状动脉的胸痛患者中的重要性.
- 要突出评估CMD和VSA的诊断实用性.
- 强调机制引导治疗的作用.
主要方法:
- 一个58岁的男性的病例报告,胸部有强力疼痛.
- 冠状动脉计算机断层扫描血管学 (CCTA) 和侵入性冠状动脉血管学.
- 综合功能评估包括冠状动脉流量储备 (CFR) 和微循环阻力指数 (IMR).
- 血管评估的冠心内乙胆诱导试验.
主要成果:
- CCTA显示边界左主狭窄;血管图显示没有关键阻塞.
- 功能评估显示了CMD (CFR=2.0,IMR=25). 功能评估显示了CMD (CFR=2.0,IMR=25). 功能评估显示了CMD (CFR=2.0,IMR=25). 功能评估显示了CMD (CFR=2.0,IMR=25).
- 乙胆测试引起了左前下降动脉中的VSA,由酸甘缓解.
结论:
- 侵入性功能测试对于诊断CMD和VSA在患有非阻塞性CAD的胸痛患者中至关重要.
- 冠状炎和VSA的共存,称为混合内型,与不良结果有关.
- 识别特定的病理生理机制使得量身定制,有效的治疗策略成为可能.
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