背景:典型变异性心绞痛是心绞痛并发心电图一过性ST段抬高,由冠脉痉挛引起。病例:一位68岁男性变异性心绞痛患者,冠脉造影后行光学相干断层扫描(Optical coherence tomography,OCT)发现右冠状动脉近端薄壁不稳定粥样斑块破裂。冠脉痉挛是变异性心绞痛的发病机制,而冠脉粥样硬化可能是引起冠脉痉挛的基础疾病,薄壁不稳定粥样斑块的破裂可能是其潜在病因。结论:不稳定斑块破裂可能会引起变异性心绞痛发作。(明确“撕裂”与“破裂”两个病理生理过程) Background: Typical variant angina pectoris is a transient ST-segment elevation of angina pectoris caused by coronary spasm. Case: A 68-year-old male with variant angina underwent coronary angiography with optical coherence tomography (OCT) to detect ruptured atherosclerotic plaque in the proximal right coronary artery. Coronary spasm is the pathogenesis of variant angina pectoris. Coronary atherosclerosis may be the underlying cause of coronary spasm. The rupture of atherosclerotic plaque may be the underlying cause. Conclusion: Unstable plaque rupture may cause variant angina pectoris. (Clear “tear ” and “rupture ” two pathophysiological processes)