狭心症に関する臨床的研究:第2報狭心症と指尖容積脈波

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Since Prinzmetal and others reported the cases of angina pectoris, in which the attacks were precipitated only at rest and accompanied by transient S-T elevation, and named it the variant form of angina pectoris in 1959, over 120 cases of this form of angina pectoris have been reported in Japan. However, there is a lot of cases which does not fully coincide with their definition. Therefore, it was thought of interest to investigate the clinical characteristics and precipitating mechanism of the attack of this form of angina pectoris. In the first paper, these problems were investigated in 12 patients with angina pectoris, in whom no laboratory findings of real myocardial infarction were observed and there exist only transient S-T elevation on ECG but no abnormal Q waves, and following results were obtained : (1) It was noted that anginal attacks were observed not only at rest but also in effort and positive exercise test was proved in almost all the cases. (2) It was observed in the majority of the cases that the attacks occurred between the mid-night and the early morning, its duration was generally within 15 minutes, and its frequency was 2-4 times a day. (3) Although the blood pressure elevated during the attack in some cases, it was unlikely that the trigger of the attack was the elevation of the blood pressure, because no elevation of the blood pressure or no increase in pulse rate was generally found immediately before attack. It is probable that the elevation of blood pressure and increase in pulse rate was not the cause but the result of the attack, being induced from the chest. pain. It was assumed that, in addition to the particiption of sympathetic nervous system, a decrease in coronary blood flow resulted from the spasm of the coronary artery may play a major role in the precipitation of the anginal attack. (4) As to the prognosis of this form of angina, in only one of 12 patients it developed to the real myocardial infaration. (5) Amyl nitrates were found to be effective for ceasing anginal pain and in the majority of the cases coronary dilators were thought to be effective in preventing precipitation of the attacks. (6) It seemed to the reasonable to widely define, in the present stage, that the variant form of angina pectoris includes any types of angina with S-T elevtion which occur not only at rest but also in effort, or that one handles these types altogether as 'the angina pectoris with S-T elevation'.<BR>In the second paper, plethysmographic changes during spontaneous anginal attacks or attacks induced by exercise loading were investigated and following results were obtained: (1) The types of pulse waves at rest were sclerotic rigid, delta and trapezoid waves indicating sclerotic changes. (2) The plethysmogram of the majority of the cases revealed a decrease in height of pulse wave and in effect of cardiac beat, and plateau formation at anginal attacks, indicating transient heart failure. (3) The occurrence of anginal attack was not observed in the patients in whom no change in the type of pulse wave was observed before and after exercise loading, although there exist distinct S-T depression, decrease in the height of pulse wave and decrease in the effect of cardiac beat. Similar phenomenon was observed in the patients with mild anginal attacks. (4) An evident increase in the ratio of arterial elasticity was observed in the patients with anginal attacks.
昭和大学・昭和医学会の論文

狭心症に関する臨床的研究:第2報狭心症と指尖容積脈波

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昭和大学・昭和医学会 | 論文

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