13例变异型心绞痛临床表现及心电图改变与冠脉造影的对照分析(1)
[摘要] 目的 探讨变异型心绞痛患者临床表现及心电图改变与冠状动脉的关系。 方法 对13例确诊为变异型心绞痛的患者进行冠脉造影。以冠脉有无病变及病变情况与临床表现及心电图改变作对比分析。 结果 ①13例变异型心绞痛患者中，冠脉造影发现有狭窄性病变11例，未发现冠脉狭窄性病变2例。②心绞痛发作时，胸前导联ST-T改变与前降支病变符合率为82%；下壁ST-T改变与右冠脉病变符合率为50%。③13例患者心绞痛发作时，心律失常发生者6例，其中快速心律失常4例，缓慢性心律失常2例。 结论 变异型心绞痛是由于在冠脉狭窄或不狭窄的基础上发生血管痉挛，导致心肌缺血所致，如不及时治疗或治疗不当，极易发生猝死，可能是冠心病心源性猝死的原因之一，应予以充分重视。
[关键词] 变异型心绞痛；临床表现；心电图；冠脉造影
[中图分类号] R541 [文献标识码] B [文章编号] 1673-7210(2012)02(b)-0156-02
, http://www.100md.com
13 cases aontrol analysis of clinical manifestation electrocardiogram changes and conronary angiography with variant angina
YANG Yiwei
Department of Cardiology, the First Hospital Affiliated to Chifeng College, Inner Mongolia Autonomous Region, Chifeng 024000, China
[Abstract] Objective To investigate the clinical manifestations and the relationship between electrocardiograph (ECG) changes and coronary artery in patients with variant angina. Methods 13 patients were diagnosed as variant angina by coronary angiography. Clinical manifestations and electrocardiogram changes according to the degree of coronary artery lesions (with or without lesion, or the situation of lesions) were analyzed. Results ① Of all the 13 patients with variant angina, stenosis lesions were found in 11 cases through coronary angiography, 2 cases were found with no coronary stenosis lesions. ② When angina attacked, the accordance rate of precardial lead ST-T changes and LAD lesions was 82%; the accordance rate of paries inferior ST-T changes and coronary artery lesions was 50%. ③ Of all the 13 patients, when angina attacked, arrhythmia happened to 6 cases of them, including 4 cases of tachycardia and 2 cases of slow arrhythmia. Conclusion Myocardial ischemia resulting from the occurrence of vasospasm based on coronary artery stenosis or not is the reason of variant angina. If doesn′t treat or treat not properly, it will lead to sudden death very easily. This may be one of the reasons of coronary heart disease sudden cardiacdeath (SCD), and it should be given adequate attention.
, 百拇医药
[Key words] Variant angina; Clinical manifestation; Electrocardiogram; Coronary angiography
变异型心绞痛(variant angina，VA)属于不稳定心绞痛的特殊类型。变异型心绞痛是一种以静息状态下胸痛发作，同时心电图出现ST段抬高，波型高尖为特点的特异类型的心绞痛。目前认为冠状动脉痉挛是引起变异型心绞痛的主要原因。由于痉挛的部位、程度、持续时间不同，其心电图的变化各有不同。本研究文对13例行冠脉造影检查，通过比较心电图与冠脉病变情况，探讨VA患者临床表现、心电图改变与冠状动脉状况的关系。现将结果报道如下：
1 资料与方法
1.1 一般资料
选择2008年7月～2010年1月在我院诊断为VA的患者，均行选择性冠脉造影检查，共计13例。其中，男11例，女2例，男∶女=5.5∶1；年龄28～65岁，平均(46.5±18.5)岁。
, 百拇医药
1.2 VA的诊断标准
以发作时肢体导联≥2个导联ST段抬高≥0.10 mV，胸前导联≥2个导联ST段抬高≥0.20 mV，与之相对应的导联的ST段压低≥0.05～0.10 mV(J点后60～80 ms)，持续2 min作为心电图诊断标准。
1.3 心律失常的发生
VA发作时体表心电图或holter记录到有关导联ST-T动态改变，同时可检出各种心律失常，随之心绞痛缓解，ST-T恢复正常，心律失常也随之消失。另外，部分患者心绞痛发作时可见U波倒置。
1.4 冠脉造影的判断
所有患者均行选择性冠状动脉造影检查。冠脉造影单支病变是指1支冠脉病变，可以是1支冠脉的多处病变。多支病变是指2支或以上的冠脉病变。
, 百拇医药
2 结果
2.1 VA发作时间
凌晨(多在1:00～7:00)9例，其他时间4例，其中1例是在跑步中发作。
2.2 VA发作持续时间
10 min以内6例(46%)；10～20 min 3例(23%)；20 min以上4例(31%)。
2.3 冠脉造影结果
13例患者中，冠脉造影发现狭窄性病变10例，其中男8例，女2例。行支架植入术者3例，均为男性患者。冠脉病变狭窄程度为30%～90%，未见完全闭塞性病变。狭窄程度在50%以下者2例，其中女性患者1例，男性患者1例，共占20%；狭窄程度在50%～75% 5例，均为男性，占50%；狭窄程度在75%以上者3例，均为男性，占30%。, http://www.100md.com(杨忆微)
[关键词] 变异型心绞痛；临床表现；心电图；冠脉造影
[中图分类号] R541 [文献标识码] B [文章编号] 1673-7210(2012)02(b)-0156-02
, http://www.100md.com
13 cases aontrol analysis of clinical manifestation electrocardiogram changes and conronary angiography with variant angina
YANG Yiwei
Department of Cardiology, the First Hospital Affiliated to Chifeng College, Inner Mongolia Autonomous Region, Chifeng 024000, China
[Abstract] Objective To investigate the clinical manifestations and the relationship between electrocardiograph (ECG) changes and coronary artery in patients with variant angina. Methods 13 patients were diagnosed as variant angina by coronary angiography. Clinical manifestations and electrocardiogram changes according to the degree of coronary artery lesions (with or without lesion, or the situation of lesions) were analyzed. Results ① Of all the 13 patients with variant angina, stenosis lesions were found in 11 cases through coronary angiography, 2 cases were found with no coronary stenosis lesions. ② When angina attacked, the accordance rate of precardial lead ST-T changes and LAD lesions was 82%; the accordance rate of paries inferior ST-T changes and coronary artery lesions was 50%. ③ Of all the 13 patients, when angina attacked, arrhythmia happened to 6 cases of them, including 4 cases of tachycardia and 2 cases of slow arrhythmia. Conclusion Myocardial ischemia resulting from the occurrence of vasospasm based on coronary artery stenosis or not is the reason of variant angina. If doesn′t treat or treat not properly, it will lead to sudden death very easily. This may be one of the reasons of coronary heart disease sudden cardiacdeath (SCD), and it should be given adequate attention.
, 百拇医药
[Key words] Variant angina; Clinical manifestation; Electrocardiogram; Coronary angiography
变异型心绞痛(variant angina，VA)属于不稳定心绞痛的特殊类型。变异型心绞痛是一种以静息状态下胸痛发作，同时心电图出现ST段抬高，波型高尖为特点的特异类型的心绞痛。目前认为冠状动脉痉挛是引起变异型心绞痛的主要原因。由于痉挛的部位、程度、持续时间不同，其心电图的变化各有不同。本研究文对13例行冠脉造影检查，通过比较心电图与冠脉病变情况，探讨VA患者临床表现、心电图改变与冠状动脉状况的关系。现将结果报道如下：
1 资料与方法
1.1 一般资料
选择2008年7月～2010年1月在我院诊断为VA的患者，均行选择性冠脉造影检查，共计13例。其中，男11例，女2例，男∶女=5.5∶1；年龄28～65岁，平均(46.5±18.5)岁。
, 百拇医药
1.2 VA的诊断标准
以发作时肢体导联≥2个导联ST段抬高≥0.10 mV，胸前导联≥2个导联ST段抬高≥0.20 mV，与之相对应的导联的ST段压低≥0.05～0.10 mV(J点后60～80 ms)，持续2 min作为心电图诊断标准。
1.3 心律失常的发生
VA发作时体表心电图或holter记录到有关导联ST-T动态改变，同时可检出各种心律失常，随之心绞痛缓解，ST-T恢复正常，心律失常也随之消失。另外，部分患者心绞痛发作时可见U波倒置。
1.4 冠脉造影的判断
所有患者均行选择性冠状动脉造影检查。冠脉造影单支病变是指1支冠脉病变，可以是1支冠脉的多处病变。多支病变是指2支或以上的冠脉病变。
, 百拇医药
2 结果
2.1 VA发作时间
凌晨(多在1:00～7:00)9例，其他时间4例，其中1例是在跑步中发作。
2.2 VA发作持续时间
10 min以内6例(46%)；10～20 min 3例(23%)；20 min以上4例(31%)。
2.3 冠脉造影结果
13例患者中，冠脉造影发现狭窄性病变10例，其中男8例，女2例。行支架植入术者3例，均为男性患者。冠脉病变狭窄程度为30%～90%，未见完全闭塞性病变。狭窄程度在50%以下者2例，其中女性患者1例，男性患者1例，共占20%；狭窄程度在50%～75% 5例，均为男性，占50%；狭窄程度在75%以上者3例，均为男性，占30%。, http://www.100md.com(杨忆微)