每日一题_2023.01.25

A 66-year-old man with a history of hypertension, diabetes mellitus, and ischemic stroke was transferred to a tertiary hospital after a cardiac arrest. For 6 months before presentation, he had recurrent exertional angina but had not sought evaluation. On the morning of the cardiac arrest, he had woken up with chest pain, lost consciousness, and regained consciousness after brief cardiopulmonary resuscitation by his family. On transfer to the tertiary hospital, findings from a physical examination and a transthoracic echocardiogram were normal. Coronary angiography revealed 50% stenosis in the middle left anterior descending (LAD) coronary artery during diastole (upper left) with complete occlusion during systole (upper right) and sluggish distal flow. Which of the following is NOT a recommended therapy for this condition?

一名有高血压、糖尿病和缺血性卒中病史的66岁男性在心脏停搏后被转至一家三级医院。在就诊前6个月内，患者反复发作劳力性心绞痛，但未就诊。在心脏停搏当天早上，患者醒来时胸痛，失去意识，在其家人进行短暂心肺复苏后恢复意识。转至三级医院时，体格检查和经胸超声心动图检查结果正常。冠状动脉造影显示左前降支中段(LAD)舒张期(左上)狭窄50%，收缩期(右上)完全闭塞，远端血流缓慢。以下哪一项不推荐用于治疗此病?

A. Beta blockers β受体阻滞剂

B. Calcium channel blockers 钙通道阻滞剂

C. Coronary artery bypass grafting 冠状动脉旁路移植术

D. Ivabradine 伊伐布雷定

E. Nitroglycerin 硝酸甘油

答案解析：

心肌桥是一种冠状动脉异常，其中心外膜冠状动脉走行肌内。有症状的患者应考虑药物治疗，但硝酸酯可能会加重症状。对于缺血风险高和/或药物治疗失败的患者应考虑手术治疗。对于这名患者，我们进行了CTA检查，显示左前降支中段冠状动脉在心肌中的深度为8 mm(底部)。这种疾病是先天性的，但可能直到晚年动脉粥样硬化并发左心室肥厚、冠状动脉微血管疾病或腔内狭窄时才会出现症状。

正确答案：E