DETRIMENTAL EFFECT OF ERGONOVINE IN HYPERTROPHIC CARDIOMYOPATHY

肥厚型心肌病患者经常出现胸痛 这种情况发生的起始阈值不同， 持续时间 这项研究旨在评估一种药理学 血管收缩剂麦角新碱对患者冠状血管的影响 患有肥厚型心肌病 24例肥厚型 心肌病和心绞痛病史，尽管心外膜正常 冠状动脉进行了冠状动脉血流和心肌 功能和代谢。 在起搏至平均心率133，18 的24名患者经历了他们典型的胸痛。 起搏期间 在给予麦角新碱后，24例患者中有22例发生胸部 痛苦 尽管麦角新碱治疗后血压明显升高 给药后，冠状动脉血流在平均起搏速率为138 次/分钟的速度显著低于起搏至类似心脏期间的速度 麦角新碱给药前的速率。 没有心外膜 麦角新碱致冠状动脉狭窄 局 因此，麦角新碱降低了冠状动脉峰值流量， 肥厚型心肌病患者，可能由于血管收缩 微血管床最大扩张，或 小动脉前小冠状动脉。 小血管冠状 血管收缩可以解释心绞痛的许多非典型特征 肥厚型心肌病患者的心绞痛，引起休息时疼痛 或者在不同程度的努力中。

Patients with hypertrophic cardiomyopathy frequently experience chest pain that occurs with variable threshold of onset and is often prolonged in duration. The study was designed to evaluate the effect of a pharmacologic vasoconstrictor agent, ergonovine, on the coronary vasculature of patients with hypertrophic cardiomyopathy. Twenty-four patients with hypertrophic cardiomyopathy and a history of angina pectoris despite normal epicardial coronary arteries underwent a study of coronary flow, and myocardial function and metabolism. During pacing to an average heart rate of 133, 18 of the 24 patients experienced their typical chest pain. During pacing after the administration of ergonovine, 22 of 24 patients experienced chest pain. Despite a significantly higher blood pressure following ergonovine administration, the coronary flow at an average pacing rate of 138 beats/min was significantly lower than during pacing to a similar heart rate prior to administration of ergonovine. There was no epicardial coronary artery narrowing during coronary angiography after ergonovine administration. Thus, peak coronary flow decreases with ergonovine in patients with hypertrophic cardiomyopathy, probably due to vasoconstriction of a maximally dilated microvascular bed, or vasoconstriction of prearteriolar small coronary arteries. Small vessel coronary vasoconstriction may explain many of the atypical features of angina pectoris in patients with hypertrophic cardiomyopathy, causing pain at rest or during variable levels of effort.