变异型心绞痛U波倒置时相变化的临床意义

为探讨U波倒置时变化的临床意义,对18例变异型心绞痛发作时一过性U波倒置与30例伴冠心病的原发性高血压患者的U波倒置特点,进行比较观察,同时,对12例变异型心绞痛患者症状控制后进行冷加压试验,观察血压升高时的U波倒置情况,并与心绞痛发作时的一过性U波倒置进行比较.结果发现两者U波倒置的时相明显不同,变异型心绞痛患者U波呈正负双相,原发性高血压患者则负正双相,认为U波倒置的时相变化具有鉴别诊断意义.     

变异型心绞痛U波倒置时相变化的临床变化

为探讨U波倒置时变化的临床意义，对18例变异型心绞痛发作时一过性U波倒置与30例伴冠心病的原发性高血压患者的U波倒置特点，进行比较研究，同时，对12例变异型心绞痛患者症状控制后进行冷加压试验，观察血压升高的U波倒置情况，并与心绞痛发作时的一过性U波倒置,结果发现两者U波倒置的时相明显不同，变异型心绞痛患者U波呈正负双相，原发性高血压患者则负正双相，认为U波倒置的时相变化具有鉴别诊断意义。     

动态心电图观察U波倒置与高血压的关系

本文通过动态心电图检查 ,发现高血压患者有一过性Ｕ波倒置 ,并将其与同步血压监测的相应时间段的血压进行比较 ,发现血压增高可引起Ｕ波倒置 ,而血压恢复正常后Ｕ波倒置消失。1　资料与方法1 1　一般资料　高血压住院患者同步进行 2 4ｈ血压测量和动态心电图检查 ,发现一过性Ｕ波倒置 46例 ,其中男 3 0例 ,女 16例 ,年龄 2 6～ 76(平均 62 )岁。慢性肾炎肾性高血压 4例 ,其余均为原发性高血压 (ＥＨ)。1 2　Ｕ波测量方法　采用美国惠普公司 463 66Ａ型双导动态心电图监测 ,同步记录ＭＶ1 及ＭＶ5导联 ,在基线平稳时测量Ｔ波后 0 0 2～ 0 …     

变异型心绞痛发作时U波倒置

心绞痛发作时心电图上ST段抬高是诊断变异型心绞痛的基础,由于历时短暂且ST段抬高常只出现在某些导联,故不易录得。U波倒置也是缺血性心脏病的特征之一,有关变异型心绞痛发作时U波倒置的报告不多。为此,作者对38例变异型心绞痛患者,在休     

一过性U波倒置对急性冠状动脉机能不全的诊断意义

本文观察5例心绞痛发作时心电图出现的一过性U波倒置(4例伴有显著的ST-T异常)者,男性4例、女性1例,年龄48～68(平均59.5)岁.分别跟踪观察24～72h.结果临床诊断为急性前壁心肌梗死1例,不稳定型心绞痛2例,变异型心绞痛2例.     

变异型心绞痛的心电图特征

变异型心绞痛常见于冠脉正常或无严重冠脉狭窄的患者，本文主要探讨变异型心绞痛患者的心电图变化。变异型心绞痛常出现典型的心电图变化，近50％的患者出现高耸对称的 T 波，如果痉挛持续则出现进行性抬高的 ST 段，持续数分钟后逐步回落。与 ST 段抬高相关的心电图改变还包括 R 波增高和 S 波减小，部分病例出现 TQ 段斜率上升、ST 段抬高和 T波深倒置的电交替。除此以外，变异型心绞痛发作时易发生室性心律失常。     

变异型心绞痛的暂时性Q波一例报告

变异型心绞痛系由于冠状动脉痉挛、心肌供氧减少而引起的一组临床-心电图综合征。其典型临床表现为周期性反复发作的静息性心绞痛;其典型心电图改变为心绞痛发作时ST段呈一过性上抬伴有对应导联ST段压低,发作缓解后心电图恢复正常。1976年以来,我院共收治九例变异型心绞痛,其中一例在发作时心电图上出现暂时性异常Q波,发作缓解后异常Q波消失,随访年余,临床上未发现急性心肌梗塞的其它征象。鉴     

不稳定型心绞痛中新出现T波倒置的解剖及预后意义

不稳定型心绞痛患者在住院期间可出现新的 T波倒置而无心脏酶的变化。虽已认识到心绞痛发作时的一过性 ST-T 波变化系反映急性心肌缺血,但对不稳定型心绞痛中伴随症状而逐渐出现的 T 波倒置的意义尚不够了解。本文目的在于:(1)确定     

40例变异型心绞痛的心电图分析

本文对40例变异型心绞痛发作时和发作后的心电图进行了分析,提出国人冠状动脉痉挛的发生率左前降支最高,其次为右冠状动脉。运动可直接或通过运动后缺血诱发冠状动脉痉挛。变异型心绞痛发作后T波倒置是较常见的现象,其反复发作可导致缺血的叠加甚至急性心肌梗塞。     

多变的T波

1 T波假性正常 急性心肌梗塞超急性期心电图T波假性正常已渐受重视,近年来又发现冠心病心绞痛发作时,缺血型T波也呈假性正常,我们遇到某些患者,静息心电图呈缺血表现,T波倒置,而心绞痛发作期心电图表现为T波由倒置转为直立,心绞痛消失后,T波又变为倒置。在做活动平板运动试验中,有患者在静息和运动中已有T波倒置的基础上加大负荷量反而出现T波直立,并伴有心绞痛而终止运动。平卧休息数分钟,心绞痛消失后,T波又转变为倒置。不少学者提到心肌缺血时心电图出现伪改善现象,即心绞痛发作时原有缺血型T波倒置转向正常直立,认为是心肌缺血加重的表现。是一过性的透壁性心肌缺血,其缺血程度远比ST段压低和T波倒置更为严重。甚至可能是心肌梗死的先兆。     

U wave inversion during attacks of variant angina.

Sequential 12 lead electrocardiograms were recorded during angina pectoris induced by ergonovine maleate in 38 patients with variant angina. Transient U wave inversion was observed in 17 patients with ST segment elevation in anterior chest leads, but in only three of 21 patients with ST segment elevation in the inferior leads associated with right coronary artery spasm. In the 17, all of whom had spasm of the left anterior descending coronary artery, the sensitivity of ST segment elevation in V5 was only 41%, and that of U wave inversion 71%. U wave inversion without ST segment elevation occurred during attacks in 35% of patients. During the recovery phase, the sensitivity of U wave inversion was 82% in V4 and 65% in V5, though ST segment elevation was absent in both V4 and V5. Thus, inverted U waves without ST segment elevation often appear in marginal ischaemic zones or during the time of recovery from temporary ischaemia. Detection of inverted U waves should aid in the diagnosis of variant angina when only lead V5 is used as a monitor and when electrocardiograms are recorded only during the recovery phase.     

Prominent negative U wave in variant angina pectoris

The extremely prominent negative U wave occasionally appears during a cardiac attack in variant angina pectoris. The clinical profile of the negative U wave was therefore studied in 80 patients with variant angina pectoris (VA) and 33 controls with resting angina pectoris (RA). The prominent negative U wave appeared in 55 of the patients with VA (68.8% of patients) and in 10 of the patients with RA (30.3%); thus, there was a significant difference in the appearance of the wave between the 2 groups of patients (p less than 0.001). The leads in which the negative U wave appeared were mostly consistent with those in which the ST segment was elevated. The negative U wave began to appear at about the time when ST-segment elevation began to improve; the wave then gradually became very prominent and then eventually disappeared. The patients with VA and also those with RA on whose ECGs the negative U wave appeared during exercise testing also had negative U waves during spontaneous episodes of angina. An investigation of the frequency of appearance of ST deviation and negative U waves during exercise testing, regardless of the type of angina pectoris, disclosed that the negative U wave appeared in 14 of 20 patients with ST-segment elevation (70% of patients), while the negative U wave appeared in only 52 of 519 patients with either no ST change or ST-segment depression (10.4%); thus, there was a significant difference in the appearance of the negative U wave between these 2 groups (p less than 0.001). Coronary cinearteriography failed to disclose any apparent difference between the appearance of the negative U wave and the presence of stenosis. The prognosis of VA and RA in patients with negative U waves was less favorable compared to those without negative U waves. In particular, we noted that of the 10 patients with RA associated with negative U waves, 4 died. Although the mechanism of the negative U wave is not yet known, we believe that the above findings contribute to its elucidation.     

Inverted U wave in ergonovine-induced vasospastic angina

The relationship between inverted U wave in leads V5 and II and the location of myocardial ischemia was studied in 52 positive patients and in 50 negative patients with ergonovine provocation test. Development of a biphasic or negative U wave, or increased negativity of U wave (inverted U wave) was observed in 15 of 17 patients with spasm in only the right coronary artery (RCA), in 6 of 8 with spasm in only the left anterior descending artery (LAD), in 2 of 8 with spasm in only the left circumflex artery (LCx), and in 23 of 24 with spasm in two or more vessels. Of 52 positive patients in the ergonovine provocation test, 46 (88.5%) had inverted U wave. Of these, 17 (32.7%) had inverted U wave without discernible ST deviation. Of 50 negative patients, 2 had inverted U wave. Inverted U wave in lead V5 was frequently seen in patients with spasm of LAD, but this finding was not uncommon in spasm of RCA or LCx. On the other hand, inverted U wave in lead II was frequently seen in spasm of RCA and LCx, but not in spasm of LAD. These findings suggest that inverted U wave in lead V5 is not specific for myocardial ischemia due to spasm of LAD and that inverted U wave in lead II is specific for spasm of RCA and LCx.     

Comparative study of myocardial ischemia during angina at rest and on exertion using thallium-201 scintigraphy

To compare the results of thallium-201 myocardial scintigraphy during angina at rest with those observed during effort angina, 81 patients were selected in whom the existence of acute myocardial ischemia was indicated both by typical transient S-T segment or T wave changes and by typical anginal pain. In these patients, scintigrams were obtained during 58 attacks of angina on effort (group 1) and during 40 attacks of angina at rest (group 2); 16 patients were studied during both types of angina. The attack at rest was spontaneous in 20 patients and induced by ergonovine maleate in 20 patients.In the presence of S-T segment elevation or transient normalization of inverted T waves, scintigrams were positive in all 24 studies at rest and in 19 of 20 studies during exercise. By contrast, in the presence of S-T segment depression scintigrams were positive in 14 (95 percent) of 15 studies during angina at rest, but in only 20 (53 percent) of 38 during angina on effort. Neither the degree of S-T segment changes nor their duration after injection of thallium was significantly different in resting studies relative to exercise studies, but the heart rate and double product were consistently higher during exercise.The marked difference in sensitivity in detecting ischemia in angina at rest with S-T segment depression compared with detection during exertional angina, even in the same patients, suggests that different pathogenetic mechanisms are responsible for the attack. Conversely, a similar mechanism operating in angina at rest and on exertion during S-T segment elevation and normalization of T waves is suggested by the similarity of thallium-201 scintigraphic findings in this situation. The findings are compatible with the hypothesis of a regional reduction in myocardial blood flow in angina at rest, independently of the direction of S-T segment change, and in exertional angina with S-T segment elevation or normalization of inverted T waves; they suggest an inadequate increase in myocardial blood flow in angina on effort with S-T segment depression.     

Value of negative U waves in coronary artery spasm

The significance of U-wave inversion during coronary arterial spasm was investigated in 188 consecutive ergometric tests performed in 69 patients. All patients had previously undergone coronary arteriography which had clearly shown coronary spasm either at rest or after a single 0.4 mg injection of ergometrine. The ergometrine tests were then performed at the patient's bedside using a standard protocol with injection of incremental doses of ergometrine: 0.05, 0.1, 0.2 and 0.4 mg every 5 minutes with 12-lead ECG recordings every minute. Fifty of the 59 patients with positive tests had classical signs of spasms: ST elevation or depression and/or T wave inversion; the other 9 patients had inversion of the U wave alone (2 cases) or associated with classical ST segment changes in the remaining cases. The 10 other patients had no ECG changes although 2 of them suffered typical anginal pain. Negative U waves were observed in 4 of the 12 patients with spasm of the left anterior descending artery, accompanied by ST elevation in the anterior wall leads. A negative U wave would appear to be a sign of less ischaemia than the classical ECG changes because anginal pain is less common: 4 out of 9 cases in which U wave inversion was a very early change, 8 out of 9 cases in which it was the first or only abnormality. The recognition of a negative U wave increases the sensitivity of the electrocardiogram during resting angina and allows earlier treatment of coronary spasm with nitrate derivatives after an ergometrine test.     

Observations on arterial blood pressure during attacks of angina pectoris

Blood pressure readings were obtained during spontaneous attacks of angina pectoris in twenty-three patients. In seven, the previous blood pressure readings were known. In three, the attacks were allowed to end spontaneously, and in twenty relief was obtained by administering nitroglycerin.In every instance the level of the systolic pressure was distinctly higher during pain than when the patient was free from pain. Although this may not be an invariable relationship, this study and a survey of the cases recently reported leads one to the conclusion that a failure of the blood pressure to rise in anginal attacks is rare.Evidence is presented to show that in patients with angina pectoris, pain alone, e. g., that of renal colic, neither produces an elevation in blood pressure nor brings on an attack of angina.Although we suspect that a temporary elevation in blood pressure is an important factor in the production of anginal attacks and may even be a necessary immediate cause of the attack, a final decision as to this relationship will require further investigation.     

变异型心绞痛胸痛发作频率与细胞内镁离子浓度的相关性探讨

目的:探讨变异型心绞痛患者胸痛发作频率与细胞内镁离子浓度的相关性。方法:18例临床诊断为变异性心绞痛患者,男6例,女12例,分为两组:A组(n=9,胸痛发作频率≥4次/周),B组(n=9,胸痛发作频率4次/周),测定患者血清、尿、红细胞内镁离子浓度,通过镁离子负荷试验测定24小时镁离子潴留率。结果:A组24小时镁离子潴留率明显高于B组(58.2±9.1%vs31.1±4.4%,P0.01);红细胞内镁离子浓度A组却明显低于B组(3.1±1.1%vs5.0±0.8fg/cell,P0.05);胸痛发作频率与24h镁离子潴留率呈正相关(r=0.69,P0.01),与红细胞内镁离子浓度呈负相关(r=-0.70,P0.01)。结论:变异型心绞痛患者胸痛发作频率与细胞内镁离子浓度高低有一定相关性。     

Prinzmetal's variant angina: Hemodynamic and angiographic observations during pain

Hemodynamic and angiographic data obtained during pain from four patients with Prinzmetal's variant angina are reported. The left ventricular pressure-time index did not increase before or during attacks of angina in three of the four patients; left ventricular systolic performance was impaired during pain in all three. In one of these three patients left ventricular pressure-volume data obtained during angina suggested a reduction in diastolic compliance; in another, pain and S-T segment elevation were present during coronary arterial spasm. The fourth patient had an increase in both arterial blood pressure and heart rate before an attack; in this patient coronary arterial spasm could not be demonstrated during the period of pain and S-T elevation. The data presented suggest that hemodynamic factors that increase the myocardial Oxygen requirements are absent and that coronary arterial spasm is present in some, but not all, patients with variant angina.     

平板运动试验时U波倒置的临床意义

目的 通过对比平板运动试验中U波倒置和ST段压低的发生情况,评价U波倒置对诊断冠心病的临床意义.方法 选择我院内科2011年8月～2013年2月心内科行平板运动试验检查的患者151例,其中男性76例,平均年龄57.9±5.16岁;女性75例,平均年龄55.4±7.09岁.对平板运动试验中出现的U波倒置和ST段下移进行对比研究和分析.结果 151例患者中,平板运动试验阳性55例,阴性96例;U波阳性33例,阴性118例.平板运动试验的阳性率36.4％,U波阳性率21.8％,卡方检验显示p=0.014;平板运动试验阳性的患者中冠脉造影阳性49例,阴性6例;U波阳性的患者中冠脉造影阳性27例,阴性6例.平板运动试验阻性的敏感性89.1％,U波阳性的敏感性81.8％,卡方检验显示p=0.578.结论 平板运动试验中U波倒置发生率较ST段下移发生率低,但冠脉造影确诊的冠心病患者中,U波倒置的敏感性和ST段下移相似,建议作为冠心病患者平板运动的阳性指标之一.     

Multivessel variant angina after a radical nephrectomy operation

A case of multivessel variant angina after an open radical nephrectomy operation (RNO) is presented. A 52-year-old man was admitted to the coronary care unit with recurrent chest pain and dynamic ST-T wave changes on electrocardiogram early after an RNO. The first diagnosis of the clinical condition was non-ST segment elevation acute coronary syndrome. However, recurrent angina with ST segment elevation occurred after the standard medical therapy, which included beta-blockers. Emergency coronary angiography showed diffuse and multiple narrowing of all the three major coronary arteries during the chest pain, which was relieved by intracoronary nitroglycerine injection. Variant angina was suspected, and beta-blocker therapy was replaced with calcium channel blocker treatment. No angina attacks were observed during the clinical follow-up. Although a direct relationship between the type of surgery and variant angina was not established, coronary vasospasm after an RNO should be kept in mind, especially in the differential diagnosis of a patient with recurrent angina and dynamic ST-T changes on electrocardiogram. Although beta-blocker therapy is a first-line treatment for all acute coronary syndromes, it can be harmful in patients with variant angina and should be stopped immediately after verification of diagnosis.