Avtor/Urednik		Fras, Zlatko
Naslov		Angina pektoris ob arteriografsko normalnih koronarnih arterijah
Prevedeni naslov		Angina pectoris with normal angiography of coronary blood vessels
Tip		članek
Vir		Med Razgl
Vol. in št.		Letnik 35, št. Suppl 2
Leto izdaje		1996
Obseg		str. 169-94
Jezik		slo
Abstrakt		The establishing of the cause of chest pain with a normal arteriogram of coronary blood vessels is difficult, since the pathophysiological mechanisms of its appearance are not clear. In a certain number of these patients these symptoms are the result of ischemia of the heart muscle due to a reduced coronary perfusion reserve. The reason for a reduction of the coronary reserve is probably an irregularly distributed and inappropriate constriction of periarteriolar blood vessels across the heart muscle. A consequence of incorrect endothelial regulation can be a functional disorder of coronary microcirculation which is shown as an insufficient vasodilatation response to metabolic and pharmacological stimuli and a hypersensitivity to vasoconstrictive stimuli (microvascular angina pectoris). Since in patients with microvascular angina pectoris it is often possible to prove an inappropriate response of smooth muscle cells in other blood vessels, it is probably a syndrome as part of a general disorder in the regulation of microcirculation. The function of the left ventricle is usually normal both at rest and during fast atrial pacing. In a certain number of patients with angina and a normal arteriogram of coronary blood vessels, it is possible to prove the formation of lactate as a result of ischemia during exertion and ECG changes characteristic of ischemia. No structural changes in blood vessels were found in biopsy samples of the endomyocardium in such patients, it is therefore especially important to distinguish this disorder from a small vessel disease. The long-term prognosis of patients with microvascular angina is excellent.
Izvleček		Opredelitev vzroka srčne prsne bolečine je ob normalnem arteriogramu koronarnega žilja težavna, saj niso jasni patofiziološki mehanizmi njenega nastanka. Simptomi so lahko posledica ishemije srčne mišice zaradi zmanjšane koronarne prekrvitvene rezerve. Za zmanjšanje koronarne rezerve je odgovona po srčni mišice neenakomerno razporejena neprimerna konstrikcija prearteriolarnega žilja. Funkcionalna motnja v koronarnimikrocirkulaciji je lahko posledica nepravilnosti endotelijskega uravnavanja, ki se kaže kot nezadosten vazodilatacijski odziv na presnovne in farmakološke dražljaje in preobčutljivost na vazokonstriktorne dražljaje (mikrovaskularna angina pektoris). Ker lahko pri bolnikih zmikrovaskularno angino pektoris pogosto dokažemo tudi neprimeren odziv žilnih gladkomišičnih celic v drugih povirjih, gre najverjetneje za sindrom v sklopu splošne prizadetosti urvnavanja mikrocirkulacije. Funkcija levega prekata je pri teh bolnikih običajno normalna tako v mirovanju kot med hitrim preddvornim spodbujanjem. Ob tem lahko pri določenem številu bolnikov s prsno bolečino in normalnih koronarogramom kot odraz ishemije med obremenitvijo dokažemo nastajanje laktata in iz ishemijo značilne EKG-spremembe. V biopsijskih vzorcih endomiokarda teh bolnikov niso našli strukturnih žilnih sprememb, zato je pomembno ločevanje mikrovaskularne angine pektoris od bolezni malih žil. Dolgoročna prognoza pri bolnikih z mikrovaskularno angino pektoris je odlična.
Deskriptorji		ANGINA PECTORIS SYNDROME X CORONARY ANGIOGRAPHY CORONARY CIRCULATION