急性心肌梗死中冠脉侧支循环的心肌保护作用

目的:探讨冠脉侧支循环对缺血心肌的影响。方法:按冠脉造影结果对152例急性心肌梗死病例分组,冠脉侧支循环发展良好者为A组,而侧支循环发育不良者为B组,对比观察两组病例心肌梗死发作后心电图的变化,以及通过左心室造影检测左室功能情况等。结果:A组的ST段抬高及病理性Q波出现较B组少;A组的左室泵功能损害亦较B组轻;B组比A组室壁瘤形成较多(P<0.05)。结论:发展良好的冠脉侧支循环对急性心肌梗死中的缺血心肌有保护作用,对左室泵功能损害减轻作用明显。     

2型糖尿病合并冠心病患者冠状动脉病变的特点和心功能的变化

目的:回顾性研究2型糖尿病(DM)合并冠心病患者冠脉病变特点以及超声心动图的异常情况,为临床预防及治疗做指导。方法:在我院行冠脉造影确诊为冠心病的患者按是否合并DM分为DM组与非DM组,分析两组超声心动图及冠脉造影特点。结果:2型DM合并冠心病组在冠脉病变特点上以三支病变、左主干、右冠、左回旋支多见;DM组的左房内径、左室舒张期末内径和收缩期末内径以及左室射血分数值与对照组相比有统计学意义。结论:2型DM合并冠心病患者并存心血管危险因素多,病变受累程度高且严重影响心功能。     

心力衰竭合并肾功能衰竭患者行冠脉造影术2例护理

2002年9月和12月我科收治了2例反复严重心力衰竭(心衰)合并肾功能衰竭(肾衰)患者,为了行冠脉造影术(冠造)以配合临床确诊和治疗,我们制定了适宜的护理措施,使患者如期康复出院。 1 病例简介 病例1,男,74岁。因反复气促、胸闷6年,加重1 h急诊入院,既往有冠心病、高血压病、慢性肾功能不全、糖尿病、十二指肠球部溃疡、肺结核病史。住院期间3次出现阿斯综合征,经电击除颤、胸外心脏按压、静脉用利多卡因后转为窦性心律,合并有心衰。入院后经强心、利尿、扩血管、降糖、抗感染、营养心肌等治疗后病情平稳,在经患者及家属同意后于局麻下行冠脉造影、肾动脉造影术,造影示:右冠状动脉、左     

中青年急性冠脉综合征合并代谢综合征的临床特点

目的观察中青年急性冠脉综合征(ACS)合并代谢综合征(MS)患者临床特点。方法中青年ACS患者137例,根据是否合并MS分为MS组和非MS组,比较2组临床特点。结果 MS组代谢异常主要表现为肥胖、高血压、高血糖脂血症、低HDL-C血症等,冠脉造影以多支血管病变和弥漫性血管病变多见。结论对冠状动脉病变严重、左室功能受损明显的中青年ACS合并MS患者及早进行个体化治疗,消除肥胖,控制血糖、血脂等,是降低心血管事件发生率及病死率,提高患者生活质量的关键。     

600例冠状动脉造影分析——重点讨论冠心病X诊断

本文报道我院1982年～1992年选择性冠状动脉造影600例的X线征象。右、左冠脉优势型及均衡型分别为332例(73.7%)、77例(17%)及44例(9.7%)。冠心病547例冠脉受累共963支,其中LM、LAD、D_1、LCX及RCA分别为50支(5.2%)、369支(38.3%)、80支(8.3%)、210支(21.8%)及254支(26.4%)。冠脉狭窄程度和支数与年龄有密切相关性。左室造影显示的左心射血分数(LVEF)与冠脉狭窄程度及是否合并室壁瘤有明显关系。狭窄严重合并室壁瘤者左室射血分数明显下降,与无室壁瘤相比P<0.01。     

男性急性冠脉综合征患者多支病变预测因素

目的 :研究急性冠脉综合征男性患者多支冠状动脉病变的临床预测因素。方法 :共 10 4例男性患者入选 ,年龄 6 4 .9± 9.6岁。综合患者的人群因素、临床特征和无创伤检查结果 (血液生化和心脏超声等 ) ,结合冠状动脉造影结果进行Logistic回归分析。结果 :冠状动脉造影结果显示单支病变 2 4例 ,多支病变 80例。以多支病变为因变量 ,慢性胸痛、血尿酸水平增高、左心室射血分数降低和左心房扩大是其有统计学意义的自变量 ,其余因素无统计学意义。结论 :慢性胸痛、血尿酸水平增高、左心室射血分数减低和左心房扩大是急性冠脉综合征男性患者多支病变的预测因素。     

超声诊断Lǒfler心内膜炎合并右冠状动脉血栓形成1例

患者男,32岁。因“突发胸痛半小时”入院。患者半小时前睡眠时突感胸痛不适,位于心前区,疼痛较剧烈,既往有嗜酸性粒细胞增多病史,无心血管病史。心电图检查示：窦性心律,Ⅱ、Ⅲ、avF导联 ST段抬高,伴 Q波形成。心脏超声检查：左房增大,左室内径正常,室间隔及左室后壁厚度正常,左室心尖部测及一约36 mm×12 mm稍低回声团块,与心内膜境界不清,内侧缘回声增强,左室下壁及后室间隔中上段搏动减弱,左室射血分数正常,为60%(图1)。超声诊断：①心尖部局部增厚(结合病史,嗜酸性粒细胞增多性心内膜炎不排除);②左室下壁及后室间隔中上段搏动减弱(右冠状动脉闭塞可能大)。血常规：嗜酸性粒细胞计数绝对值0.94×109/L,百分比9.1%;急诊以“冠心病急性下壁心肌梗死”收住院进一步治疗。急诊行冠状动脉血栓取出支架植入术,冠状动脉造影示左主干正常、左前降支粗大,血流缓慢,未见明显狭窄,左回旋支粗大,血流缓慢,未见明显狭窄,右主干自近段起完全闭塞,可见血栓影,抽出条索状血栓1条,复查造影狭窄消失,取栓术后冠脉血流灌注良好分级为3级。冠脉血栓病理检查见嗜酸性粒细胞浸润。     

冠心病患者冠状动脉病变程度与左室功能的关系

目的:研究冠心病患者的冠状动脉病变严重程度与左室收缩和舒张功能的关系。方法:2009年6月—2010年3月因疑似冠心病行冠状动脉造影的患者223例,均进行冠状动脉造影明确冠心病诊断并评价冠状动脉病变程度;行左室造影前记录左室压力曲线,自动分析计算出左室舒张末压(left ventricular end-diastolic pressure,LVEDP)和左室压力下降时间常数(thetime constant of left ventricular pressure decay,tau);行超声心动检查获取左室射血分数(left ventricular ejection fraction,LVEF)。根据冠状动脉造影结果,患者分为无病变组(n=43)、单支病变组(n=76)、2支病变组(n=62)、3支病变组(n=42)。对比分析冠脉病变严重程度与心脏收缩和舒张功能的关系。结果:左室室壁厚度、左室质量指数、LVEF、LVEDP和tau值在4组间差异有统计学意义(P均<0.05);冠状动脉3支病变组患者的LVEDP较单支病变组显著升高(P=0.004)。结论:冠心病患者左室舒张功能和收缩功能受损,左室收缩舒张功能随冠脉病变程度增加而下降。     

冠脉血流显像无创评估心肌梗死缺血区侧支循环的初步临床观察

目的 观察冠脉血流显像无创技术对心肌梗死缺血区的侧支循环状况,以期建立无创检测缺血区侧支循环新方法。方法 冠心病心肌梗死患者8例,采用心尖两腔切面观察前后降支及心肌内血流,左室短轴切面观察前后室间隔支的血流,频谱多普勒测量血流速度。结果８例患者经冠脉造影证实有不同途径的侧支交通,后降支与前降支末梢相交通者５例,前降支为逆向充盈、冠脉血流显像检查前降支远端可见收缩期为主和舒张期为主的逆向血流各１例,后降支远端测及舒张期反向血流１例;有前后室间隔支相交通的６例（由前间隔支至后室间隔支２例和后间隔至前间隔支４例）,冠脉血流显像检查时可见明显增强的前后室间隔支的血流信号并向缺血区延伸,频谱显示为舒张期为主的反向血流,造影显示由对角支和回旋支与前降支中部相交通的２例,冠脉血流显像仅探测到对角支内血流增快,为１.5m/s。另外,冠脉血流显像在１例前降支起始部闭塞的患者中观察到由左室腔进入缺血的前壁的血流束,频谱以舒张期为主,峰速为０.49m/s。结论 冠脉血流显像技术可直观显示心肌梗死患者的侧支循环血流,可作为冠脉造影的重要补充。     

代谢综合征对冠心病冠脉病变程度的影响分析

目的:探索代谢综合征对冠心病冠脉病变程度的影响。方法:对214例急性冠脉综合征(ACS)住院患者,分别计算血糖、血脂、体重指数、血压等指标。据代谢综合征有与无分为两组,分析两组冠状动脉造影情况。结果:合并代谢综合征患者组体重指数、空腹血糖、甘油三脂均明显高于非代谢综合征组(P≤0.05)。餐后2 h血糖明显高于非代谢综合征组(P≤0.01)。代谢综合征组积分值明显高于非代谢综合征组(P=0.023),多支病变率明显高于非代谢综合征组(P=0.008 7)。结论:代谢综合征加重冠心病冠脉病变进展,尤其是多支血管受累明显。     

乳腺放疗与乳腺癌幸存者发生冠心病的临床特征分析

目的:比较女性乳腺癌幸存者与普通女性初次诊断冠心病的临床特点.方法:回顾性选取2013年1月至2019年12月徐州医科大学附属医院心内科通过冠状动脉(冠脉)造影诊断为初发冠心病的80例女性乳腺癌幸存者为乳腺癌冠心病组,选取2019年1月至12月诊断为初发冠心病的313例女性非乳腺癌患者为非乳腺癌冠心病组,比较2组的危险...     

2型糖尿病病程与冠心病病变程度的相关性分析

目的探讨不同年限2型糖尿病合并冠心病患者的冠状动脉造影特点。方法从冠状动脉造影病例中选取符合冠心病诊断标准的病例206例,其中非糖尿病患者62例、2型糖尿病患者124例(病程≤5年41例、>5年～≤10年38例、>10年～≤20年45例)。分析比较各组之间的临床资料和冠状动脉病变特点。结果糖尿病≤5年组和>5年～≤10年组冠状动脉的病变数量以及病变程度、形态与非糖尿病组比较,差异均无统计学意义;而糖尿病>10年～≤20年组患者冠状动脉发生多支病变以及弥漫病变、闭塞病变明显高于其他组(P<0.01)。结论随2型糖尿病病程的延长,冠状动脉病变逐渐广泛和严重。     

Cardiac risk factors in polio survivors

OBJECTIVE: To assess the prevalence of dyslipidemia and other risk factors for coronary heart disease in a sample of polio survivors with and without postpoliomyelitis syndrome. DESIGN: Retrospective chart review. SETTING: A multidisciplinary outpatient postpolio clinic. PARTICIPANTS: Eighty-eight consecutive symptomatic postpolio patients, 50 women (mean age, 59.0y; range, 36-81y) and 38 men (mean age, 61.2y; range, 44-83y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Presence of risk factors for coronary heart disease: clinical atherosclerotic disease, male age >or=45 years or female age >or=55 years, history of hypertension (blood pressure >or=140/90mmHg or on antihypertensive medication), diabetes mellitus, cigarette smoking, and high-density lipoprotein (HDL) less than 35mg/dL. Obesity (body mass index [BMI], >25kg/m(2)) was assessed as an intervention target. Laboratory values included fasting total cholesterol, HDL, low-density lipoprotein, triglycerides, and glucose. RESULTS: Of the total sample, 61.3% had dyslipidemia. Average HDL cholesterol ratio was 4.01 (women, 3.68; men, 4.55). Forty-four patients (50%) had a history of hypertension or had elevated blood pressure. Seven patients (8%) had a history of diabetes or had elevated fasting blood glucose (>110). Eighteen patients (20.4%) were smokers or had a history of smoking; 9 continued to smoke and 9 had quit smoking. Twenty-five patients (28.4%) were overweight (BMI, >25kg/m(2)). Forty-one patients (46.5%) had more than 1 risk factor for coronary heart disease. Nine of the total sample (10.2%) had a history of heart disease ranging from atrial fibrillation to angina. Only 19 patients had a previous diagnosis of dyslipidemia and only 12 were on a lipid-lowering medication. CONCLUSION: Polio patients have a high prevalence of dyslipidemia. The study sample supports the National Cholesterol Education Program's Adult Treatment Panel III statements that hypercholesterolemia is underdiagnosed and undertreated. The postpolio population carries a high prevalence of 2 or more coronary heart disease risk factors. Evaluation and rehabilitation of polio patients should include screening for dyslipidemia and education about elimination of controllable risk factors.     

潍坊地区汉族人群PON1(对氧磷酶)Q192R基因多态性与冠心病的相关性研究

目的:测定PON1(对氧磷酶)Q192R基因多态性及在人群中的分布,分析各基因型与冠心病的关系。方法:冠心病患者128例,男80例,女48例,年龄为36~82(65.25±9.83)岁,全部病例有明确心梗病史或经冠状动脉(冠脉)造影确诊。正常对照组110例,男66例,女44例,年龄31~87(63.52±7.91)岁,选自人群健康查体的随机个体。结果:PON1Q192R有QQ、QR、RR三种基因型,正常人的基因型频率分别为0.200 0、0.490 9、0.309 1,冠心病组QQ、QR、RR三种基因频率分别为0.226 6、0.531 3、0.242 1。结论:潍坊地区汉族人群PON1(对氧磷酶)基因多态性和冠心病无关。     

Acute coronary events in female residents of Tomsk. Results of 5-year observation (1994-1998)

AIM: To study epidemiology of acute coronary conditions (ACC) including acute myocardial infarction (AMI) and acute coronary failure (ACF) among female population of Tomsk aged over 20 years and trends for 5 years. MATERIAL AND METHODS: 1919 ACC episodes were compared in the women: 1616(84.2%) cases of AMI and 303(15.8%) cases of ACF. The comparison concerned epidemiological indices: morbidity, hospital and prehospital ACC lethality, the disease history, pathomorphological evidence. RESULTS: ACC prevalence among women for 5 years remained at the level 2.0-2.2 cases per 1000 women of the same age. Number of ACC patients with progressive angina decreased while number of cases of cardiogenic shock went up in paralled decrease of the number of episodes of acute left ventricular failure, arrhythmia and abnormal conduction. AMI as macrofocal occurred more frequently, ACC hospital lethality rose (due to more cases in patients over 60). Autopsy showed more cases of stenosing atherosclerosis of coronary arteries. CONCLUSION: No changes for the better occurred for 5 years among female population of Tomsk in relation to ACC incidence and mortality. This necessitates introduction of measures of effective primary and secondary prevention of ischemic heart disease and arterial hypertension.     

动脉粥样硬化性缺血性脑卒中病人他汀类药物服用情况及影响因素分析

[目的]探讨动脉粥样硬化性缺血性脑卒中病人他汀类药物服用情况及影响因素。[方法]选取2018年1月-2018年12月收治的动脉粥样硬化性缺血性脑卒中病人344例为研究对象,使用自行设计的调查问卷收集病人的人口学资料和基础疾病,记录病人入院前服用他汀类药物、抗血小板药物情况;根据入院时服用他汀类药物情况分为服用他汀类药物组、未服用他汀类药物组。测定病人血清低密度脂蛋白(LDL-C)浓度,以LDL-C<2.6 mmol/L为血脂达标统计达标率。[结果]344例缺血性脑卒中病人中服用他汀类药物106例(30.81%),服用他汀类药物组血脂达标率明显高于未服用他汀类药物组,差异有统计学意义(P<0.01)。服用他汀类药物组与未服用他汀类药物组病人年龄、吸烟史、冠心病史、糖尿病史、高脂血症史、服用抗血小板药物情况比较差异有统计学意义(P<0.01)。多因素Logistic回归分析显示,吸烟史、冠心病史、糖尿病史、高脂血症史、服用抗血小板药物是他汀类药物服药依从性的独立影响因素。[结论]动脉粥样硬化性缺血性脑卒中病人他汀类药物服药率和血脂达标率均偏低,应针对相关影响因素进行针对性干预,提升二级预防效果。     

Smoking habits and predictors of continued smoking in patients with acute coronary syndromes

BACKGROUND: Most patients with acute coronary syndrome quit smoking when hospitalized, although several have been found to relapse and resume smoking within 3 months. AIM: This paper reports a study to identify factors that can predict who will resume smoking after hospitalization for an acute coronary syndrome. METHODS: Patients (n = 1320) below the age of 75 years, admitted to a Swedish university hospital coronary care unit with acute coronary syndromes, between September 1995 and September 1999, were consecutively included. Data were collected from hospital medical records and included information on previous clinical history, former illnesses and smoking. During their hospitalization, an experienced nurse interviewed the patients by using a structured questionnaire to obtain additional information. Patients were followed up 3 months after the discharge. Those who continued to smoke (non-quitters) were compared with those who had stopped (quitters) with regard to age, sex, medical history, clinical course, and intention to quit. To identify factors independently related to continued smoking, a logistical regression in a formal forward stepwise mode was used. RESULTS: Of the patients admitted, 33% were current smokers. Three months after discharge, 51% of these patients were still smoking. There were no significant differences in age, gender or marital status between non-quitters and quitters. In a multivariate analysis, independent predictors of continued smoking were: non-participation in the heart rehabilitation programme (P = 0.0008); use of sedatives/antidepressants at time of admission (P = 0.001); history of cerebral vascular disease (P = 0.002), history of previous cardiac event (P = 0.01); history of smoking-related pulmonary disease (P = 0.03) and cigarette consumption at index (P = 0.03). CONCLUSIONS: Smoking patients who do not participate in a heart rehabilitation programme may need extra help with smoking cessation. The findings may provide means of identifying patients in need of special intervention.     

Evaluation of myocardial ischemia in Kawasaki disease using an isointegral map on magnetocardiogram

The authors have recently reported on the usefulness of the isointegral mapping technique using magnetocardiography (MCG) for the diagnosis of adult ischemic heart disease. This study evaluated myocardial ischemia in patients with Kawasaki disease (KD). The ischemia has been considered difficult to diagnose with a standard ECG. The study included 32 patients (age 3 +/- 22 years, mean 12.9 +/- 4.1 years, +/- SD) with a history of KD and 21 age-matched healthy children. Coronary arterial lesions were present in 13 patients of the KD group, MCG was carried out at rest with a multichannel superconducting quantum interference device (SQUID) system. The integral value was computed for each channel and isointegral maps were constructed during depolarization and repolarization processes. In all subjects of the control group, the integral value of repolarization was higher than that of depolarization and the isointegral map of these two processes showed similar patterns. However, the integral value of repolarization in four cases with KD (one with a history of myocardial infarction, two with a stenotic lesion in the left coronary artery, one with an aneurysmal and stenotic lesion in the right coronary artery) was lower than that of depolarization, and abnormal patterns were evident in the isointegral map. All but the case with myocardial infarction showed only mild abnormalities or almost normal on the ECG. Although sensitivity of the method for detection of myocardial ischemia was not fully assessed because of the small number of cases with significant coronary arterial stenosis, noninvasive isointegral mapping technique using the MCG could be useful for evaluation of myocardial ischemia in patients with KD.     

Coronary artery bypass graft surgery in older women and men.

OBJECTIVE: To compare women and men younger than 70 years of age and 70 years or older undergoing coronary artery bypass surgery. DESIGN: Retrospective chart review, case-control series. SETTING: University medical center. PATIENTS: All women (n = 465) having first-time isolated coronary artery bypass surgery between 1983 and 1988, and 465 men matched for age and year of surgery. Predominantly white; 33% were 70 years or older. MEASURES: Medical record data: demographics, preoperative comorbidities, perioperative and postoperative complications, mortality, length of stay. RESULTS: Preoperatively, women 70 years of age or older had a higher incidence of congestive heart failure, renal disease and hypertension, and a lower incidence of smoking history compared with women less than 70 years old. Men 70 years or older had a higher incidence of congestive heart failure and renal disease, and a lower incidence of smoking history compared with men less than 70 years old. There was no difference in mortality between older and younger women, whereas the mortality rate for older men was higher than that for younger men. There were fewer differences between women younger than 70 and those 70 years or older in incidence of postoperative complications than between men of those same age groups. Among patients 70 years or older, incidence of postoperative congestive heart failure was greater in women than in men. There were no other differences between women and men younger than 70 and those 70 years or older in incidence of postoperative complications. Controlling for the influence of postoperative complications, age was related to length of stay for women and men. CONCLUSIONS: Older women were at no greater risk of mortality or the occurrence of postoperative complications compared with younger women or older men. A functional component influencing recovery and length of hospital stay needs to be considered to provide optimal nursing care after surgery.     

Women's interpretation of their coronary heart disease symptoms.

BACKGROUND: Men and women are known to delay in seeking medical attention when experiencing acute cardiac symptoms. However, women are more likely to have had chronic undifferentiated symptoms prior to an acute episode and then when experiencing an acute episode delay longer than do men. Studies have shown once women do present they tend to be further along the disease trajectory than men. AIMS: The aim of this study was to explore women's own interpretation of the presenting symptoms they experienced. METHODS: Twenty-nine women consented to take part in semi-structured interviews that focussed on their experience of coronary heart disease (CHD). The women's narrative around the initial disruption of their illness was analysed focusing on routine and reconstructed forms of narration. RESULTS: The results showed that many failed to recognise and act on their symptoms. Most only sought medical attention after family or friends intervened. None of the women had seen themselves at risk of developing coronary heart disease despite many have a strong family history. CONCLUSION: The women's early symptoms of coronary heart disease were often undifferentiated and difficult to interpret by the women themselves. There is a need for further research to understand and recognise early symptoms of coronary heart disease in women. This will allow women and health professionals to assess risk and identify women with coronary heart disease early on in their disease trajectory so therapy to prevent the morbidity associated with coronary heart disease and acute life threatening episodes will be reduced.