DETRIMENTAL EFFECT OF ERGONOVINE IN HYPERTROPHIC CARDIOMYOPATHY

肥厚型心肌病(HCM)患者常出现胸部 起病阈值可变的疼痛，通常持续时间长于 持续时间。这项研究旨在评估一种药理作用 血管收缩药麦角新碱对患者冠脉系统的影响 与胡志明市。23例有心绞痛病史的肥厚型心肌炎患者 尽管正常的心外膜冠状动脉接受了冠状动脉的研究 血流、心肌力学和新陈代谢。在走动过程中达到平均水平 23名患者中有18人经历了典型的胸部 疼痛。在给麦角新碱后的起搏过程中，23人中有21人 患者经历了胸痛。尽管血液浓度明显升高 压力，冠脉血流量平均起搏频率为138 心率/分钟显著低于单独起搏时，与类似 心率。心外膜冠状动脉未见狭窄。 重复冠状动脉造影术。因此，冠脉流量峰值随着 麦角新碱在肥厚性心肌病患者中的作用，可能是由于血管收缩。 微血管床最大扩张，或小动脉前血管收缩 冠状动脉很小。小血管冠脉血管收缩可能 解释心绞痛患者的许多不典型特征 在休息时或在不同程度的努力时引起疼痛的HCM。

Patients with hypertrophic cardiomyopathy (HCM) 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 cornoary vasculature of patients with HCM. Twenty-three patients with HCM and a history of angina pectoris despite normal epicardial coronary arteries underwent a study of coronary flow, myocardial mechanics, and metabolism. During pacing to an average heart rate of 133,18 of the 23 patients experienced their typical chest pain. During pacing after the administration of ergonovine, 21 of 23 patients experienced chest pain. Despite a significantly higher blood pressure, the coronary blood flow at an average pacing rate of 138 beats/min was significantly lower than during pacing alone to a similar heart rate. There was no epicardial coronary artery narrowing during a repeat coronary arteriography. Thus, peak coronary flow decreases with ergonovine in patients with HCM, 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 HCM causing pain at rest or during variable levels of effort.