RESUMEN
In a 60-year-old man with exercise-dependent anginal symptoms, reversible ST segment elevations of maximally 0.8 mV occurred in the anterior chest leads during ergometric exercise at 75 W. Angiography excluded coronary artery stenoses. To demonstrate whether he had exercise-dependent vasospastic angina, angiography was performed during bicycle ergometry. At 75 W the typical symptoms recurred, accompanied by ST elevations in the ECG. At the same time, spasm in the region of the anterior interventricular branch was demonstrated angiographically; it disappeared at once after intracoronary injection of 200 micrograms nitroglycerin. The patient subsequently remained free of symptoms while taking isosorbide dinitrate (120 mg daily) and nifedipine (80 mg daily).
Asunto(s)
Angiografía Coronaria , Vasoespasmo Coronario/etiología , Electrocardiografía , Esfuerzo Físico/fisiología , Angina de Pecho/diagnóstico , Angina de Pecho/tratamiento farmacológico , Angina de Pecho/etiología , Enfermedad Crónica , Vasoespasmo Coronario/diagnóstico , Vasoespasmo Coronario/tratamiento farmacológico , Quimioterapia Combinada , Prueba de Esfuerzo , Humanos , Dinitrato de Isosorbide/uso terapéutico , Masculino , Persona de Mediana Edad , Nifedipino/uso terapéuticoRESUMEN
The clinical and hemodynamic findings of 96 adult patients with ostium secundum defect are presented. There are no interrelationships between the extent of symptoms and clinical state on one side and heart size, shuntvolume and other hemodynamic parameters on the other hand. Our observations do not allow firm conclusions as the the natural course of the affection. It can be stated however, that this congenital cardiac malformation can be associated with a normal life exspectancy and without severe symptoms for decades. Hence we see problems as to the indication of the surgical closure of the defect, since not much is known about the longstanding usefulness of surgery in respect to a possible prolongation of life exspectancy and diminuition of morbidity. We therefore are of the opinion that - until such data are available - the indication for surgery should not be guided by prospective nonproved assumption but by the clinical state of the patient and the severity of his symptoms.