心绞痛发作时异常心电图假性正常化的临床意义

目的探讨心绞痛发作时异常心电图假性正常化的临床意义。方法回顾性分析1386例心绞痛患者的临床资料，观察心绞痛发作时ST-T改变。结果1386例中有32例（2．31％）心绞痛发作时原来心电图异常的ST-T出现假性正常化，其中经治疗好转22例（68．75％），发生急性心肌梗死8例（25．00％），死亡2例（6．25％）；而1354例无假性正常化患者中。好转1226例（90．55％），发生急性心肌梗死92例（6．79％），死亡32例（2．66％），差异均有显著性意义（X^2=47．12,19．03，5．54，P〈0．01）结论心绞痛发作时心电图假性正常化应视为严重心绞痛发作，且易发生急性心肌梗死或猝死；应尽早有效解除冠状动脉痉挛、抗凝治疗，并积极控制危险因素。     

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.     

Isolated left anterior hemiblock during attacks of angina pectoris]

The clinical significance and mechanism for changes in the axis of the QRS complex during attacks of angina pectoris (excluding cases of Prinzmetal's angina) are unknown. Previous work has suggested that left anterior hemiblock under these circumstances is a sign of unstable angina indicating a lesion in the anterior descending artery. Two cases with left anterior hemiblock associated with frequent attacks of angina have been the subject of careful study. In case one, atrial stimulation tests showed that the left axis deviation was not related to tachycardia. It only occurred when atrial stimulation was carried out for long enough to induce myocardial ischaemia as witnessed by precordial pain and disorders of repolarisation. In case two, the left anterior hemiblock came on at first at the same time as the attacks of angina, and then became permanent. Bypass graft of the anterior descending artery restored the QRS axis to normal, and corrected the repolarisation disorders which were of ischaemic origin. These findings argue in favour of an ischaemic origin of this conduction defect. Unlike ischaemia of the left anterosuperior subbranch, anterior left hemiblock is indicative of extensive ischaemia of the anterior wall of the left ventricle relative to an obstruction in the anterior descending artery or in the main trunk of the left coronary artery.     

The effect of generalized anoxemia on the electrocardiogram of normal subjects. Its bearing on the mechanism of attacks of angina pectoris

It was found that the induction of generalized anoxemia in normal subjects produced a diminution in the amplitude of the T-wave, at times leading to its inversion. At the same time the S-T segment was depressed and at times became negative. Similar changes were produced by generalized anoxemia in patients suffering from angina pectoris. These electrocardiographic changes occurred without the appearance of anginal pain in the normal subjects and in four of six patients suffering from angina pectoris. However, two of the six patients with angina pectoris did develop typical mild anginal pain.It is therefore concluded that some process in addition to anoxemia (or ischemia) is concerned in the production of the pain of angina pectoris. This process is a variable which prevents the accurate prediction of the occurrence of pain during induced anoxemia. Because of the variability in the results and of the hazard to the patient, the use of induced anoxemia as a test for the presence of angina pectoris is of questionable value.     

The diagnostic value of epinephrine in angina pectoris

Epinephrine as a test for angina pectoris was found to be unreliable in regard to both the symptoms produced and the electrocardiographic changes. This unreliability makes the test of little value, particularly in view of the severe reactions sometimes encountered.     

Incidence, characteristics and coronariographic significance of myocardial ischemia during daily life in patients with angina pectoris

OBJECTIVES: To evaluate the incidence, characteristics and angiographic significance of myocardial ischemia detected on Holter monitoring in a group of patients with stable angina pectoris. SETTING: Department of Cardiology of a Central Terciary Hospital. METHODS: In 24 patients (pts) with stable angina pectoris and proven coronary artery disease (11 pts with left main or three vessel disease; 13 pts with one or two vessel disease), a 24 hour Holter monitoring was performed. Two groups of ischemic episodes were considered: Group I with 65 ischemic episodes detected in pts with left main or three vessel disease and group II constituted by 17 ischemic episodes detected in pts with one or two vessel disease. RESULTS: The incidence of myocardial ischemia was 91% in pts with left main or three vessel disease and 46% in pts with one or two vessel disease. Statistically significant differences were seen between group I and II concerning the mean heart rate variation from two minutes before onset of ST-segment depression to its onset (3.5 bpm vs 7.4 bpm; p less than 0.05) and from the onset of ST-segment depression to its maximal depression (6.5 bpm vs 15 bpm; p less than 0.000001). CONCLUSIONS: The presence of myocardial ischemia and some of its characteristics on Holter monitoring seem to have a relation with the severity of coronary artery disease in patients with stable angina pectoris.     

The prognostic significance of post-infarction angina pectoris and the effect of verapamil on the incidence of angina pectoris and prognosis

The prognostic sign of angina pectoris and the effect of interventionwith verapamil on the incidence of angina pectoris were studiedin patients recovering from myocardial infarction and includedin the Danish Verapamil Infarction Trial II. During the secondweek after admission patients were double-blindly randomizedto treatment with verapamil 360 mg. day^–1 or placebo.Treatment was continued for up to 18 months. At discharge anginapectoris was reported in 11% of 869 patients randomized to verapamiland in 12% of 888 randomized to placebo (ns). One month afterdischarge a significantly increase in the prevalance of anginapectoris was reported in both the verapamil (33%) (P<0·001)and the placebo groups (39%) (P <0·001). The one monthprevalence of angina pectoris (P=0·03) and the 18 monthsoverall incidence of angina pectoris (P= 0·002) wereboth .sigificant lower in the verapamil group compared withplacebo. Stable angina pectoris during the first month of follow-upwas a significant predictor of major events (i.e. death or reinfarction)(hazard ratio = 1·45; 95% confidence limits: 1·101·89). As verapamil significantly reduced the incidenceof angina pectoris during daily activities, and thereby thenumber of patients at high risk, the beneficial effect of verapamilin reducing major events in patients recovering from myocardialinfarction is likely to be due to abolishing myocardial ischaemia.     

Chronobiological study of ischemic attacks in angina pectoris at rest

The aims of this study were to determine if the hourly distribution of ischaemic episodes differed as regards ST segment elevation or ST segment depression during ischaemic attacks and differed as regards the degree of coronary atherosclerotic involvement. Twenty-four in-patient drug free subjects with angina at rest underwent ECG continuous Holter monitoring for periods varying from 24 to 168 hours. Four groups of patients were identified: group 1A: 6 patients with ST elevation and 0-1 vessel disease; group 1B: 6 patients with ST elevation and 2-3 vessel disease; group 2A: 3 patients with ST depression and 0-1 vessel disease; group 2B: 9 patients with ST depression and 2-3 vessel disease. During Holter monitoring, 301 ischaemic episodes were registered in group 1A during 576 hours; 173 episodes were registered in group 1B during 624 hours; 41 episodes were registered in group 2B during 528 hours. Using the single and population mean cosinor tests on the episodes of each group, considered as a whole, the following results were found: group 1A showed a circadian rhythm with acrophase at 4:03 a.m. (Fig. 2), group 1B showed a circadian rhythm with acrophase at 10:51 a.m. (Fig. 3), group 2A showed a circadian rhythm with acrophase at 11:15 p.m. (Fig. 5), while group 2B showed ultradian rhythms which lasted 7 and 13 hours (Fig. 6). The chronobiologic analysis of the distribution of the ischaemic attacks confirmed the existence of a circadian rhythm of ischaemic episodes in patients with ST elevation.(ABSTRACT TRUNCATED AT 250 WORDS)     

Coronary stenosis in angina pectoris with normal resting electrocardiogram]

The arteriographic abnormalities found in 104 patients with typical angina pectoris and an electrocardiogram at rest which was normal at the time of arteriography were compared with those of 238 cases with typical angina pectoris, but with an abnormal electrocardiogram (127 having ST/T changes, 111 having transmural necrosis). There was no major difference between the two groups as far as the degree of coronary stenosis was concerned, nor in its extent and distribution. However, by comparison with the group with an abnormal electrocardiogram, very tight stenoses of the three trunks or of one trunk alone were slightly less common in the patients with a normal electrocardiogram; also, for each of the three trunks, the index of the lesion was slightly less raised, and the circumflex and right coronary arteries were slightly less commonly, affected, although the difference was not usually great enough to achieve significance. The action of the left ventricle and/or the value of left ventricular end-diastolic pressure were, however, manifestly better conserved in those with a normal electrocardiogram (p less than 0.001). An aorta-coronary bypass graft is more likely to be indicated in this group of patients.     

动态心电图监测变异型心绞痛4例

变异型心绞痛属于自发型心绞痛的一种类型,冠状动脉痉挛是引起其发作的重要原因之一。现就2011年6月～2012年4月来我院动态心电图室就诊的4例变异型心绞痛患者的心电图做简要分析。1临床资料例1:男,51岁,因夜间阵发性胸闷胸痛1周来院检查。常规心电图:ST-T改变(图1)。24小时动态心     

The prognostic significance of angina pectoris experienced during the first month following acute myocardial infarction

Background: Angina pectoris accompanied by transient ST-segment changes during the in-hospital phase of acute myocardial infarction (AMI) is a well established marker of subsequent cardiac death and reinfarction. Hypothesis: This study was undertaken to record the prognostic significance of angina pectoris experienced during the first month following discharge from AMI. Methods: In all, 803 patients included in the placebo arm of the Danish Verapamil Infarction Trial II were followed up for 18 months in 20 coronary care units in Denmark. The patients were randomized to placebo and were still on study treatment 1 month after discharge. Of these patients, 311 (39%) reported chest pain during the first month following discharge. Results: Patients with angina pectoris had a significantly increased risk of reinfarction [hazard 1.71; 95%-confidence limit (CL): 1.09, 2.69] and increased mortality risk which, however, only reached borderline statistical significance (hazard 1.52; 95%-CL: 0.96, 2.40). When patients were subdivided according to both angina pectoris and heart failure, those with one or both of these risk markers had significantly increased mortality (p 0.03) and reinfarction (p 0.02) rates compared with patients free of both angina pectoris and heart failure. Conclusion: Patients with postinfarction angina pectoris have a significantly increased morbidity risk.