日本小児循環器学会雑誌 Pediatric Cardiology and Cardiac Surgery

Online ISSN: 2187-2988 Print ISSN: 0911-1794
特定非営利活動法人日本小児循環器学会 Japanese Society of Pediatric Cardiology and Cardiac Surgery
〒162-0801東京都新宿区山吹町358-5アカデミーセンター Japanese Society of Pediatric Cardiology and Cardiac Surgery Academy Center, 358-5 Yamabuki-cho, Shinju-ku, Tokyo 162-0801, Japan
Pediatric Cardiology and Cardiac Surgery 33(3): 259-264 (2017)
doi:10.9794/jspccs.33.259

症例報告Case Report

心筋シンチグラムで心室前中隔の血流低下を認め微小血管狭心症と判断した16歳女児例Case of a 16-year-old Girl Diagnosed with Microvascular Angina on the ground of a Perfusion Defect in the Anteroseptal Wall Using Myocardial Scintigraphy

1公益財団法人田附興風会医学研究所北野病院小児科Department of Pediatrics, Kitano Hospital Tazuke Kofukai Medical Research Institute ◇ Osaka, Japan

2公益財団法人田附興風会医学研究所北野病院心臓センターCardiovascular Center, Kitano Hospital Tazuke Kofukai Medical Research Institute ◇ Osaka, Japan

受付日:2016年11月30日Received: November 30, 2016
受理日:2017年5月15日Accepted: May 15, 2017
発行日:2017年5月1日Published: May 1, 2017
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微小血管狭心症は,表在冠動脈に器質的狭窄や攣縮を伴うことなく,微小冠動脈の循環障害に起因する狭心症と定義される.中高年,とくに閉経後の女性に好発する疾患であるが,今回16歳という若年で本疾患を発症したと考えられる一例を経験したので報告する.症例は,16歳女児で,労作時の胸痛と心電図で軽度のST低下を指摘されて当院に紹介となった.身体所見,血液検査では特記すべき異常は認めなかった.運動負荷により硝酸薬抵抗性の狭心痛が出現し,201TI心筋シンチグラフィで心室前中隔の虚血を認めた.冠動脈造影では狭窄および攣縮は認めなかったが,エルゴノビン負荷で前下行枝(LAD)に血流速度の低下を認めた.上記結果から微小血管狭心症と判断した.β遮断薬とCa拮抗薬の併用で治療を開始し,胸痛頻度の低下と心筋シンチグラフィで虚血所見の改善傾向を認めている.近年,本疾患の予後は必ずしも良好でない可能性が示唆されている.非常に稀ではあるが胸痛を訴える若年者の中に本例のような病態の可能性があることを念頭におき,適切に治療することは重要であると考える.

Microvascular angina is defined as chest discomfort with normal epicardial coronary arteries, and it is caused by coronary microvascular dysfunction. It is relatively more prevalent in women who are perimenopausal or postmenopausal and is rare in young women. Here we report the case of a 16-year-old girl who presented with a complaint of chest discomfort during exercise and who was diagnosed with microvascular angina. Exercise stress induced chest discomfort, which was not relieved by administering nitroglycerin. Exercise thallium-201 myocardial scintigraphy showed a perfusion defect in the anteroseptal wall. Although no significant stenosis or vasospasm in the epicardial coronary arteries was observed on the angiography, the ergonovine stimulation test induced chest discomfort and delayed distal vessel opacification in the left anterior descending coronary artery. In addition to limiting exercise, concomitant treatment using carvedilol and diltiazem reduced the frequency of chest pain. The perfusion defect showed improvement. Because microvascular angina is very rare in young patients, they might be misdiagnosed. Recent evidence has challenged the assumption that microvascular angina is a benign condition; therefore, early treatment may be very important for young patients. Physicians who examine young patients with angina-like chest discomfort should be aware of the possibility of microvascular angina.

Key words: microvascular angina; cardiac syndrome x; scintigraphy; pediatric

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