无痛性心肌缺血的动态心电图观察与分析

无痛性心肌缺血 (ＳＭＩ) ,又称隐性冠心病[1 ] 。ＳＭＩ造成的心肌损害 ,不次于有症状心肌缺血。无症状往往不能引起患者警觉 ,严重者可发生心肌梗死并发致命心律失常而猝死。现回顾性分析10 6例心肌缺血的动态心电图 (ＤＣＧ) ,以探讨ＳＭＩ的临床特点及其发生规律。1　资料与方法男 66例 ,女 40例 ,年龄 45～ 76岁。采用美国Ｄｅｌ、Ｍａｒ公司生产的ＤＣＧ仪 ,选择ＭＶ1 、ＭＶ3、ＭＶ53导联 ,全信息连续记录2 4ｈ心电图。参照检测病人的生活日态 ,观察ＳＴ段缺血型下移时是否伴有心绞痛、及与生活状态的关系。ＳＭＩ的诊断标准是“1× …     

无痛性心肌缺血的动态心电图分析

无痛性心肌缺血(SMI),系指具有心肌缺血的客观证据,但缺乏胸痛及心肌缺血相关的主观症状,临床上又称隐性心肌缺血。在未确诊的冠心病患者中,SMI远较心绞痛多见,它与冠心病的预后与猝死有着因果关系。动态心电图(DCG)是临床上检测SMI重要方法之一,对评估SMI的预后有重要意义。现报告如下。     

动态心电图对无痛性心肌缺血探讨

无痛性心肌缺血(SMI)可能为心肌梗死(CMI)和猝死的先兆。早期发现可进行合理治疗,对预防MI和猝死有重要意义。现应用DCG对SMI作监测和分析,报告如下。 1 资料与方法 1.1 资料 2000年9月～2002年9月     

老年心肌缺血患者181例动态心电图分析

<正>随着人口老龄化的加剧,冠心病(CHD)等心血管疾病发病率增高,心肌缺血是CHD患者的主要临床表现之一,部分患者伴有胸闷、胸痛、呼吸困难等临床症状,也有一部分患者并无上述明显症状而易被忽视,引起严重后果〔1〕。因此,积极监测并发现无症状心肌缺血患者并予以治疗可有效改善患者预后。本文对我院检测到有心肌缺血改变的老年患者的动态心电图资料进行回顾性分析,并结合有无临床症状进行比较。1临床资料与方法     

冠心病无症状心肌缺血的动态心电图分析

元症状性心肌缺血(SMI)一般元典型临床症状,较难确诊,易被忽视。动态心电图Holter)的应用日趋广泛,对冠心病人的诊断作用已被世人所公认,有关冠心病心肌缺血发作规律的研究也更进一步深入。本文应用Holter检测冠心病人110例,以探讨冠心病人SMI发作时的某些规律。     

168例动态心电图无痛性心肌缺血分析

本文以动态心电图(DCG)检查测出无痛性心肌缺血(SMI)的缺血性ST-T改变。用美国GP公司生产的3导DCG机监测连续24h记录,同时记录24h活动情况。检出发生心肌缺血294例次,其中ST水平型或下斜型压低228例次,SMI者183例次,占80．3％,T波倒置66例次,SMI者57例次,占86．4％。常规心电图对SMI的检出率极低,而24hDCG检查可弥补其不足。     

冠心病心肌缺血动态心电图的临床分析

目的探讨冠心病者心肌缺血与心律失常的关系。方法应用动态心电图（DCG）进行临床分析,监测135例冠心病者心肌缺血发生阵次、每次缺血发作时间和ST段最大压低,以及昼夜缺血次数。结果无痛性心肌缺血（SMI）92例,占68．1％;伴典型心绞痛12例,占8．8％;心肌缺血发作时,快频率依赖者86例,占63．7％。昼夜发作规律为6：00—12：00发生最高,检出694阵次占57.9％。结论DCG对心肌缺血和心律失常的种类、时间、数量与日常活动的关系、变化规律以及药效可进行详细的观察,是监测心肌缺血和心律失常有效方法之一。     

老年人无症状心肌缺血动态心电图分析

目的：探讨影响老年冠心病无症状心肌缺血（SMI）的因素及其意义。方法：经动态心电检查，选择152例冠心病SMI患者，按年龄分为两组，＞60岁为A组。＜60岁为B组。结果：分析比较显示A组活动时SMI发生率，SMI出现的阵次，心律失常发生率均高于B组（P＜0.05或P＜0.01）。两组SMI的昼夜分布及与心率的关系无明显差别（P＞0.05）。结论：老年SMI患者SMI、心律失常发生率高。     

动态心电图在心肌缺血监测中的意义

在冠心病患者的动态心电图监测中发现,除有症状性心肌缺血外,还有无症状性心肌缺血(SMI)存在。SMI患者比有症状者预后更差、猝死发生率更高。因此,SMI的临床意义更大。现将我院一组冠心病患者经     

Diagnostic and prognostic value of ambulatory ECG (Holter) monitoring in patients with coronary heart disease: a review

Silent ischemia, the most common expression of atherosclerotic heart disease, affects approximately 30–50% of patients during their activities of daily living. The present review provides a comprehensive and practical summary of current knowledge on perioperative myocardial ischemia through MEDLINE searches up to June 2005, using keywords including “silent ischemia,” “transient ischemia,” and “Holter monitoring.” Holter monitoring (i.e., continuous ambulatory ST-segment monitoring) is an effective tool for assessing the frequency and duration of silent transient myocardial ischemia, particularly in patients who are post-acute myocardial infarction (MI), those with acute coronary syndromes (ACS), and in patients in the acute post-operative period. Holter monitoring allows for further risk stratification of patients who have a positive exercise ECG by collecting long-term ECG data on ischemic and arrhythmic events while patients perform routine activities. Both the presence and increased duration of transient ischemia as detected by continuous ST-segment Holter monitoring are associated with increased rates of coronary events and mortality. Holter monitoring may aid in the identification of patients and subgroups of patients with ACS who may derive the greatest benefit from antiplatelet and antithrombotic therapy. Indeed, many ongoing and upcoming trials of pharmacotherapy include ischemia on Holter monitoring as an endpoint.     

动态心电图监测老年冠心病无症状心肌缺血的意义

目的:探讨24小时动态心电图(Holter)对老年冠心病患者无症状心肌缺血(SMI)的检出情况。方法:回顾分析我院门诊及住院336例老年冠心病患者的临床情况和Holter资料。结果:(1)常规心电图检出心肌缺血106例(31.55％),Holter检出心肌缺血220例(65.48％);SMI发生率为69.09％,有症状心肌缺血发生率为30.91％;(2)SMI发作有明显生物节律,以清晨6-12时发作频率最高;(3)SMI发作时心率减慢的比例明显低于有症状心肌缺血的(P<0.005);(4)SMI的心律失常检出率为93.4％。结论:Holter可早期发现老年人的无症状心肌缺血,有重要价值。     

动态心电图550例的临床分析

目的探索550例动态心电图的临床意义。方法使用美国GP公司BMS Hoher连续记录24h心电图进行分析。结果496例有心律失常、心肌缺血，阳性率达90．18％。器质性疾病386例，占70．18％。结论Hoher检出率较高，是临床诊断的重要依据，是及早提供介入治疗、减少心血管重大事件的必要检查手段。     

无症状心肌缺血患者动态心电图与冠状动脉CT血管造影的对比分析

目的:比较不同程度无症状性心肌缺血(SMI)患者,冠状动脉CT血管造影(CTA)改变是否存在差异,探讨SMI患者动态心电图改变与冠状动脉CTA改变的关系。方法:利用12导联动态心电图筛选出SMI患者进行冠状动脉CTA检查,同时对无SMI但存在多重冠心病危险因素的患者进行冠状动脉CTA检查,作为对照组,对二者的结果进行对比分析。结果:随着心肌缺血负荷值的增加,冠状动脉CTA改变程度加重,无SMI患者冠状动脉CTA阳性率较SMI患者明显较低。结论:SMI患者动态心电图改变与冠状动脉CTA改变有显著的相关性。     

Ⅱ型无症状性心肌缺血的冠状动脉成形术的探讨

目的观察心肌梗死伴无症状性心肌缺血(Ⅱ型无症状性心肌缺血)病史与冠状动脉成形术(PTCA)前后冠脉狭窄程度的关系;通过分析运动平板试验与冠状动脉病变关系,初步探讨此类患者PTCA适当时机及效果.方法选择47例,男41例,女6例,平均年龄55.7±9.7)岁初发急性心肌梗死(AMI)1个月以上,运动平板心电图示心肌缺血的无症状患者行冠状动脉造影术观察PTCA术前后冠脉狭窄程度.结果心肌梗死病史不超过3个月与超过3个月比较,前者术前狭窄程度虽大(P<0.05),但多支病变数少(P<0.05),PTCA术后狭窄程度明显减少(P<0.005),须支架术者也少(P<0.05).运动平板心电图试验阳性组虽术前狭窄程度明显高于强阳性组(P<0.001)和低血压组(P<0.005),但术后狭窄程度比较,前者明显低于后二者和严重室性心律失常组(P均<0.005).结论对于心肌梗死后无症状性心肌缺血患者,应尽早行冠状动脉造影术,3个月以内行成形术效果较好;运动平板试验阳性结果者PTCA术比强阳性、严重室性心律失常、低血压和心绞痛者效果佳.     

A survey of patients selected by general practitioners for home care of suspected myocardial infarction: arrhythmia detection using Holter monitoring

From the Lancaster district (pop. 50 000) 101 patients wereselected for home care of suspected acute myocardial infarction(AMI) by their general practitioners (GPs) and 78% were seenwithin 6 h (44% within 2 h). Infarction was confirmed in 54cases compared with 203 in the coronary case unit over the sameperiod. Reasons given for home management were stable condition(48%), diagnostic doubt (34%), patient preference (18%).goodhome (15%), age (14%). Holter ECGs from 97 patients were analysed to see if arrhythmiaswere undetected clinically and recordings of at least 20 h wereobtained in 88 (91%). Symptoms drew attention to atrial arrhythmiasin 5 patients. Ventricular premature beats were recorded in96% of the AMI group (84% of the non-MI), ventricular tachycardiain 21% of the AMI patients (5% non-MI), atrial fibrillationin 25% of AMI (7% non-MI) and complex ventricular ectopic activity(Lown 3–5) was found in 81% of the AMI (58% of the non-MI).Weconclude that the GPs in the Lancaster district select patientsfor home care of AMI on clinical and social grounds rather thantime after onset. Holter ECG recordings reveal major arrhythmiaswhich are usually undetected clinically and are at least ascommon as those found in CCU treated patients. Further studiesinvolving larger numbers of home treated patients monitoredearly are required to identify criteria for home care.     

阿托伐他汀改善陈旧性心肌梗死患者心功能及其运动耐量的作用

目的 观察阿托伐他汀对血脂正常的陈旧性心肌梗死病人心功能及运动耐量的治疗影响。方法 选择57例陈旧性心肌梗死病人，随机分为2组，分别给予消心痛10mg口服，每日三次，连用8周或阿托伐他汀10mg口服，每日一次连用8周，并比较两组每周心绞痛发作次数、硝酸甘油消耗量，心功能及运动耐量。结果 阿托伐他汀减少心绞痛发作次数与硝酸甘油消耗量，而运动导致出现趼段压低1mm与心绞痛所需时问增加，ST段缺血型下移明显减少；左室射血分数、心输出量左室短轴缩短分数均增加，但左室舒张末期内径无明显变化。结论 阿托伐他汀可改善运动诱发的心肌缺血，并提高心功能及运动耐量。     

老年无症状心肌缺血患者外周血活化血小板检测分析

目的：探讨老年无症状心肌缺血患与老年对照组的外周血活化血小板的差异。方法：用荧光抗体对20例老年无症状心肌缺血患与34例老年对照作血液标记，以流式细胞术进行测试，用Simulset程序获取数据并分析结果，用PEMS软件进行统计。结果：老年无症状心肌缺血组较老年对照组CD62P明显不同，差异有显性（P＜0．05）。结论：活化血小板百分比与无症状心肌缺血的发生呈正相关，可作为老年无症状心肌缺血免疫诊断的指标之一。     

ST segment analysis for assessment of coronary artery patency: comparison of surface ECG and Holter recordings.

In a prospective trial in 124 patients with acute myocardial infarction, Holter and surface ECG recordings were obtained simultaneously and compared for their ability to assess thrombolysis-induced ST segment changes. Accuracy in predicting patency of the infarct-related artery was evaluated in both methods. Success or failure of thrombolysis was determined angiographically 90 min after the start of therapy. For both methods, sensitivity, specificity, and positive predictive value for correct prediction of the perfusion status ranged between 64% and 92%. However, the negative predictive value was considerably lower (40-53%). There were no significant differences in any parameter evaluated for either method. Thus, two surface ECG recordings before and 2 h after the start of therapy yield the same predictive value as continuous Holter monitoring with respect to thrombolysis-induced coronary artery reperfusion. However, for triage of patients to early coronary interventions, more sophisticated methods are needed for non-invasive prediction of coronary artery patency due to the low negative predictive value of ST segment analysis.     

Silent myocardial infarction and risk of heart failure: Current evidence and gaps in knowledge

Coronary heart disease (CHD) is the most common underlying risk factor for heart failure (HF); up to one-third of the patients who are hospitalized for HF each year in the United States have a history of myocardial infarction (MI). Although silent MI (SMI) could account for up to one-half of all MIs, only a few studies examined the relationship between SMI and risk of HF. These few studies agreed on their conclusions that SMI is associated with increased risk of HF. However, there was less agreement on the magnitude of risk and the sex differences in the association between SMI and HF, which is probably due to the heterogeneity in how these studies defined SMI. This report summarizes and discusses the current evidence linking SMI to HF, the impact of the methods by which SMI is defined on the reported relationship between SMI and HF, the potential mechanisms for such relationship, the implications of these findings, and the gaps in knowledge that need to be addressed.