NONATHEROMATOUS ISCHEMIC-HEART DISEASE FOLLOWING WITHDRAWAL FROM CHRONIC INDUSTRIAL NITROGLYCERIN EXPOSURE
NONATHEROMATOUS ISCHEMIC-HEART DISEASE FOLLOWING WITHDRAWAL FROM CHRONIC INDUSTRIAL NITROGLYCERIN EXPOSURE
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DOI：
10.1161/01.cir.46.4.666
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发表时间：
1972-01-01
期刊：
影响因子：
37.8
通讯作者：
COOLIDGE, G
中科院分区：
文献类型：
--
作者：
LANGE, RL;TRESCH, DD;COOLIDGE, G
本报告描述了临床，血管造影和血流动力学的结果，在9例患者表现为非动脉粥样硬化性缺血性心脏病引起的慢性工业暴露于硝酸甘油和随后退出。在200名具有类似暴露的工人中，其发病率接近5%。1例患者突然死亡，该病一般无先兆症状。在8名幸存者中，有5人接受了研究，没有人显示出明显的器质性阻塞性疾病。然而，在一项研究中，在戒断状态下，冠状动脉和指动脉痉挛被证明，并很容易逆转硝酸甘油。存活者表现出运动功能和血流动力学损害类似于其他缺血性心脏病心肌功能障碍患者。其中1例发生完全性左冠状支阻滞伴晚期猝死，另1例出现慢性复发性房颤，一个有吸引力的假说认为慢性血管舒张引起稳态血管收缩，后者在停药期心肌缺血持续存在。需要对有机硝酸盐的血管扩张作用和体内平衡反应进行更详细的研究。此外，应根据这一工业经验审查长期服用强效、长效有机硝酸盐类药物的效果。
This report describes the clinical, angiographic, and hemodynamic findings in nine patients who manifested nonatheromatous ischemic heart disease induced by chronic industrial exposure to nitroglycerin and subsequent withdrawal. They represent nearly 5% incidence in the group of 200 workers with similar exposure. One patient died suddenly, and the disease was commonly without premonitory symptoms. Of the eight survivors, five were studied and none showed evidence of significant organic obstructive disease. However, in one studied during the withdrawal state, coronary and digital arteriospasm was demonstrated, and was readily reversed by nitroglycerin. Survivors exhibited exercise symptomatology and hemodynamic impairment similar to other patients with myocardial dysfunction from ischemic heart disease. Complete left bundle-branch block with late sudden death occurred in one, and chronic recurrent atrial fibrillation is present in a second.An attractive hypothesis suggests that chronic vasodilatation evokes homeostatic vasoconstriction, the latter persisting during the withdrawal period with cardiac ischemia. A more detailed study of the vasodilator action of organic nitrate and the homeostatic reaction is warranted. In addition, the effect of chronic administration of potent, longacting organic nitrate-based drugs should be examined in the light of this industrial experience.