冠状动脉痉挛诱发心律失常的临床特点及治疗效果

目的探讨冠状动脉痉挛（CAS）诱发心律失常的临床特点及治疗效果。方法选择1998年7月至2008年12月期间入住本院的16例CAS患者，CAS的诊断根据病史和症状，结合标准12导联心电图、动态心电图及冠状动脉造影等检查确定。结果16例患者CAS发作时伴有心绞痛和心电图ST段抬高。全部病例均合并缓慢性和／或快速性心律失常，其中缓慢性心律失常6例，二、三度房室阻滞5例，窦性静止1例；快速性心律失常12例，其中持续性室性心动过速（室速）和心室颤动（室颤）5例，非持续性室速5例，室性早搏2例。冠状动脉造影显示，4例冠状动脉完全正常，4例冠状动脉狭窄等于或超过50％，其余8例冠状动脉狭窄均≤45％。全部病例均接受了大剂量钙拮抗剂和硝酸酯类的联合抗血管痉挛治疗。冠状动脉有明显狭窄的4例患者接受了介入治疗。除1例患者死亡外，其余患者平均随访（52．3±18．9）个月，无心绞痛及晕厥发作。结论有或无冠状动脉病变的CAS均可诱发缓慢性和／或快速性室性心律失常；除针对冠状动脉基础病变治疗外，地尔硫革和硝酸酯类等联合抗痉挛治疗是主要的治疗措施。

Coronary artery spasm induced arrhythmias:its characteristics and therapeutical effects

Objective To agsess the clinical characteristics and cardiac arrhythmias induced by coronary artery spasm(CAS)and its therapeutical effectiveness.Methods Sixteen cases with CAS were enrolled from July,1998 to December,2008.Diagnosis of CAS was based on patient's history and symptoms,12-lead electrocardiogram,Hoher record and coronary angiography.Results Angina pectoris and ST segment elevation were found in all patients and bradyarrhythmias and/or tachyarrhythmias occurred in all cases during CAS,inchding Ⅱ-Ⅲ° AV block in 5,sinus arrest in 1,sustained ventricular tachycardia(VT)and ventricular fibrilladon in 5,nonsustained VT in 5,and premature ventricular beats in 2 cases.Cownary angiography Was normal in all cases except 4,who had≥50%stenosis and 8,who had less than 45%stenosis.Calcium antagonists and nitrates in large dose were given to all patients.Four patients with severe stenosis underwent interventional procedures.Fifteen patients had no angina pectoris and syncope,but one patient died during follow-up period of mean(52.3±18.9)months.Conclusion CAS can induce bradyarrhythmias and/or tachyarrhythmias in padents with or without coronary artery lesions.Anti-vasospasm therapy with calcium antagomsts and nitrates is very important in patients with CAS.