每日一题_2023.03.13

A 45-year-old man visited his primary care physician one month ago because of chest pain that he had experienced four times in the past four months. The onset of the pain is sud- den and radiates to his left jaw. He has experienced this pain while watching television but has never felt it during exercise. During last month’s visit, the physician prescribed sublingual nitroglycerin, and the patient reports that this has shortened the duration of his episodes. Last month’s ECG is shown in the image. Which of the following is the most likely cause of this patient’s chest pain?

一名45岁男性在过去4个月里经历了4次胸痛，一个月前到初级保健医师处就诊。疼痛一开始就发作，并向左下颚放射。他曾在看电视时经历过这种疼痛，但在运动时从未有过这种感觉。在上个月的就诊中，医生给病人开了硝酸甘油的处方，病人说这缩短了他发作的持续时间。图中显示了上个月的心电图。下列哪项是该患者胸痛最可能的原因?

(A) Myocardial infarction 心肌梗死

(B) Pericarditis 心包炎

(C) Prinzmetal’s angina 变异型心绞痛

(D) Stable angina稳定型心绞痛

(E) Unstable angina不稳定型心绞痛

答案解析：

该患者有心脏缺血的典型症状:突然发作的胸痛，放射至左肩或左下颌，舌下含服硝酸甘油可缓解。然而，患者年轻，疼痛不是由活动引起，而是在休息时发生。此外，他的心电图正常，没有梗塞或缺血的证据。因此，他可能患有冠状血管痉挛，也被称为变异型心绞痛。

正确答案：C