冠状动脉痉挛对不稳定型心绞痛发作有何影响

冠状动脉痉挛对不稳定型心绞痛发作有何影响朴龙松①刘朝中目前认为不稳定型心绞痛的主要发病机制是与冠状动脉的斑块破裂继发血栓形成有关，是何原因引起斑块的破裂目前尚不清楚。本文观察了１８６例不稳定型心绞痛病人，在冠脉造影中对冠状动脉内注射硝酸甘油的反应，旨...     

变异型心绞痛发病机制及治疗进展

变异型心绞痛为不稳定型心绞痛的一种特殊类型,是冠状动脉痉挛引起心肌氧供量减少所致,以心绞痛在安静时发作,并伴有短暂ST段抬高为特征,可能导致急性心肌梗死、晕厥、严重心律失常和猝死.血管内皮功能障碍导致的一氧化氮缺乏和Rho激酶途径介导的血管平滑肌收缩功能增强是冠状动脉痉挛的主要原因,其他诱发因素包括自主神经活性失衡、慢性低度炎症、镁缺乏和遗传易感性.钙离子拮抗剂、长效硝酸盐和Rho激酶抑制剂可抑制冠状动脉痉挛,介入和外科手术治疗可预防恶性心血管事件发生.本文就变异型心绞痛在发病机制和治疗方面的研究进展作一综述.     

重新认识冠状动脉痉挛

冠状动脉痉挛在缺血性心脏病包括稳定性心绞痛,不稳定性心绞痛,急性心肌梗死以及猝死的发生机制中占有重要地位。近些年,影像技术包括冠状动脉强化CT,血管内超声以及光学相干断层成像技术（OCT）的应用对冠状动脉痉挛病理的探讨有了新的进展。冠状动脉痉挛患者的临床表现也多种多样。因此,对于冠状动脉痉挛需要再深入广泛的重新认识。     

冠状动脉痉挛的诊断与治疗现况

冠状动脉痉挛是已公认的心肌缺血的重要机制,它是产生变异性心绞痛以及冠状动脉造影正常或接近正常的其它类型心绞痛的主要原因。有人称这些心绞痛为血管痉挛性心绞痛(Vasospasticangina)。同时,有固定的冠状动脉粥样硬化病     

变异型心绞痛发病机制及临床特点研究进展

变异型心绞痛主要由冠状动脉痉挛引起,患者胸痛发作时,伴有心电图ST段一过性抬高。变异型心绞痛发病与冠状动脉内皮细胞功能障碍、炎性反应及自主神经系统失衡、Mg~(2+)缺失等有关,临床表现除胸痛外,还可有各种心律失常、晕厥甚至猝死。深入了解变异型心绞痛的发病机制、临床特点,有助于指导临床用药及介入方法的选择。本文就变异型心绞痛发病机制、临床特点的研究进展作一综述。     

冠状动脉痉挛的临床表现及其诊断与治疗

冠状动脉痉挛是指心脏的一支或多支冠状转输动脉发生局部的或弥散性的暂时性收缩。冠状动脉痉挛不仅是变异型心绞痛的直接原因,而且也与急性心肌梗塞(AMI)心脏性猝死等病有密切的联系。因此,加深对冠状动脉痉挛的认识,有其重要意义。冠状动脉痉挛的临床表现一、变异型心绞痛与冠状动脉痉挛:据统计,住入冠心病监护系统的不稳定心绞痛病人中,变异型心绞痛约占20～30%。这类病人的临床表现是:①、心绞痛的性质与部位与典型心绞痛相似,疼痛发作一般在安静条件下,常见于后半夜至清晨,呈周期性的特点。②、心绞痛发作严重时,常并发严     

冠状动脉痉挛的现代认识

冠状动脉痉挛是指一时性冠状动脉直径减少。以往对冠状动脉痉挛在冠心病的发生、发展及预后的影响一直没有引起临床重视。从70年代后,随着诊断技术的发展,对冠状动脉痉挛的诊断率不断提高,人们才认识到冠状动脉痉挛不仅可引起变异型心绞痛,也可引起稳定型或劳力型心绞痛,大的冠状动脉持续性痉挛,不但能引起急性心肌     

利心平(Nifedipine)治疗冠状动脉痉挛

变异型心绞痛发作时常伴有威胁生命的心律失常,有时可导致病人死亡,其发病机制一般认为系冠状动脉痉挛所致。对这类冠状动脉痉挛的病人,近年来发现一组很有希望的新药:钙游子通道阻滞剂,它们具有强力的扩张冠脉的作用。这组新药中临床经验     

ST段抬高型心绞痛患者动态心电图与冠状动脉造影分析

ST段抬高型心绞痛的发生机制不甚清楚,既往认为与冠状动脉痉挛有关。本研究对18例动态心电图显示ST段抬高型心绞痛患者进行冠状动脉造影,旨在明确其冠状动脉病变情况及动态心电图特点。     

奥扎格雷对不稳定心绞痛患者血小板指标的影响

不稳定性心绞痛（UAP）是介于稳定性心绞痛和急性心肌梗死的一种临床症候群,有增加心源性死亡和心肌梗死的危险。其发病机制是冠状动脉粥样斑块破裂,血小板聚集与黏附增加,冠状动脉痉挛,血栓形成,冠状动脉管腔不完全性阻塞。对其治疗有两个目的 ：即刻缓解缺血和预防     

VARIANT ANGINA IN THYROTOXICOSIS

Thyrotoxicosis may exacerbate angina pectoris in patients with coronary artery disease but angina also occurs in thyrotoxic patients with normal coronary arteries. Four female severely thyrotoxic patients presented with apparent angina pectoris as a manifestation of their thyrotoxicosis. Two of them had transiently abnormal ECGs during pain. Treatment for thyrotoxicosis immediately stopped the chest pain, which did not recur. All patients had negative exercise ECGs, and one had a normal coronary angiogram. The possible mechanisms to explain this phenomenon are discussed. Coronary artery spasm has been demonstrated in thyrotoxic patients previously and may explain the features in these patients. An alternative hypothesis is that myocardial metabolism is fundamentally changed by thyrotoxicosis. We would recommend that thyroid function assessment should be considered in young female patients with atypical angina.     

Histamine-induced coronary artery spasm: the concept of allergic angina.

Histamine, the main amine released during allergic reactions, can provoke coronary arterial spasm manifested as angina pectoris. This has been shown during clinical and laboratory studies. The effects of histamine on cardiac function are mediated via H1- and H2- receptors situated on the four cardiac chambers and coronary arteries. Coronary arteries of cardiac patients are hyperactive and contain stores of histamine which can initiate coronary artery spasm. Clinical observations indicate that angina pectoris or acute myocardial infarction can be provoked by acute allergic reaction. The coincidental occurrence of chest pain and allergic reaction accompanied by clinical and laboratory findings of classical angina pectoris seems to constitute the syndrome of allergic angina. The clinical symptoms of allergic angina include chest discomfort, dyspnoea, faintness, nausea, pruritus and urticaria. They are accompanied by signs such as hypotension, diaphoresis, pallor and bradycardia. There are also electrocardiographic findings indicating myocardial ischaemia, arrhythmias and conduction defects. Thus, in patients undergoing acute allergic reaction, the development of chest pain could be explained by the mechanism of coronary arterial spasm provoked by the release of histamine, which constitutes the syndrome of allergic angina.     

Spasm of organically altered coronary arteries

The paper is concerned with 11 patients with an angiographically recorded spasm at the site of the coronary artery stenosis. In the 2 patients, the spasm was spontaneous, whereas in the 9, it was provoked by ergometrine. None of the patients had a typical clinical picture of Prinzmetal's angina pectoris, but all the cases were characterized by exacerbation of coronary heart disease, which was manifested by repetition and increase of the intensity of attacks of angina pectoris at rest. The data of the repeated ergometrine tests, during which the ECG was recorded indicate that in the majority of the patients, the ability to respond by spasms toward ergometrine administration disappeared as the clinical condition was stabilized, but some of the patients preserved this ability despite therapy with calcium antagonists. If 2 or 3 coronary vessels were involved, spasm developed but in one of the vessels. This is indirect evidence for the fact that during multiple stenosing of the coronary arteries, the reactivity of one of the stenoses plays the leading part in the genesis of the disease exacerbation.     

三磷酸腺苷负荷超声造影在冠状动脉痉挛诊断中的应用

目的探讨三磷酸腺苷负荷超声造影在冠状动脉痉挛诊断中的应用。 方法收集2019至2020年在东莞康华医院行三磷酸腺苷负荷超声造影及冠状动脉造影,诊断为冠状动脉痉挛的典型病例5例,对其临床特点、冠状动脉造影特点及负荷超声造影检查过程中三磷酸腺苷的剂量用法和出现阳性结果时室壁运动及心肌灌注特点进行总结分析,同时对三磷酸腺苷负荷超声造影在冠状动脉痉挛诊断中的应用经验进行总结。 结果5例患者中,4例最大耐受剂量为240 μg/（kg·min）,1例最大耐受剂量为220 μg/（kg·min）。前4例患者在停药后9~11 min出现阳性反应,后1例患者仅停药3 min即出现阳性反应。左心室壁受累节段最多者高达6个（病例1）,最少3个（病例2,3）。5例冠状动脉造影结果均为轻度以下狭窄。超声造影与冠状动脉造影一致程度较高的2例,一般的2例,不一致的1例。5例患者均在延迟恢复期方出现冠状动脉痉挛所致的节段运动和灌注异常;心肌灌注和室壁运动异常先于心电图ST-T改变和心绞痛症状发生,5例患者在检查过程中均未出现胸痛症状。 结论三磷酸腺苷负荷超声造影用于诊断冠状动脉痉挛性心绞痛,在超声造影条件下能很好观察到心肌运动及心内膜灌注异常,即心肌缺血,早期发现心肌运动异常并及时停药可确保检查安全有效。     

Characteristics of the clinical manifestations of stenocardia in patients with ischemic heart disease, without myocardial infarct, in relation to the state of the coronary bed

Mono- and multifactorial discriminant analyses aided by computer were used in 106 patients with coronary disease to compare the clinical and angiographic findings common to different manifestations of angina pectoris. The relationship was discovered between the clinical form of angina pectoris and the gravity of lesions of the coronary artery. Intracardiac hemodynamics and left ventricular contractility at rest did not differ whatever the patients' group. According to the bicycle ergometry test, the physical exercise tolerance was lower in patients with progressive angina pectoris and depended on the gravity of coronary artery lesions. The outcome of the clinical manifestations of angina pectoris during observation at hospital was mainly influenced by the natural course of coronary disease, primarily stipulated by obstruction in the coronary arteries. Using the multifactorial discriminant analysis aided by computer, the classifying signs were outlined, making it possible to differentiate between the groups of angina pectoris patients depending on the duration of angina pectoris attacks (in minutes), irradiation of pain to the shoulder or to both arms, T wave inversion on the ECG, and the gravity of coronary artery obstruction. The given signs enable one to recognize patients with destabilization of the clinical course of angina pectoris.     

Myocardial ischemia from coronary arterial spasm.

Spasm of coronary arteries can cause chest pain indistinguishable from classic angina pectoris in patients without atherosclerosis of these vessels or recognizable heart disease. Associated electrocardiographic changes usually correspond to the coronary artery affected and disappear when the attack of pain ends. Sublingual nitrates are excellent agents for the control of the episodic anginal symptoms. There have been scattered reports of myocardial infarction occurring in patients with normal coronary arteries; a role of arterial spasm in these cases in speculative.     

不伴心肌梗死的冠状动脉完全闭塞病变心绞痛的临床分析

目的：探讨不伴心肌梗死的冠状动脉完全闭塞病变心绞痛患者的临床特点。方法：对24例不伴心肌梗死的冠状动脉完全闭塞患者的临床表现、心电图、超声心动图及冠状动脉造影资料进行回顾分析。结果：中、高危险组主要表现为静息心绞痛，低危险组和稳定性心绞痛组主要表现为劳力型心绞痛。冠状动脉造影显示左前降支闭塞10例（37％），右冠状动脉闭塞7例（26％），左回旋支闭塞6例（22％），合并多支血管病变23例（95．8％）。心电图ST段异常14例（58．3％）。62．5％的患者进行经皮冠脉血运重建术。结论：不伴心肌梗死的冠状动脉完全闭塞主要表现为劳力型心绞痛，心电图ST段异常是预测冠脉病变严重程度的主要危险因素。经皮冠状动脉介入治疗正成为慢性冠状动脉闭塞的主要手段之一。     

急性冠脉综合征患者临床及冠状动脉造影分析

目的 初步探讨急性冠脉综合征患者的冠脉病变及临床特点。方法 对42例急性冠脉综合征及20例稳定型心绞痛患者的临床资料及选择性冠状动脉造影的结果进行分析。结果 急性冠脉综合征患者中 ,危险因素≥2个者占88.1% ;不稳定型心绞痛组多支病变比率占65.2% ;与稳定型心绞痛组比较 ,不稳定型心绞痛组冠状动脉狭窄程度无显著性差异(p>0.05) ,B型、C型病变的比例在急性心肌梗塞组与不稳定型心绞痛组明显增高(p<0.01)。 结论 急性冠脉综合征的致病过程 ,并不完全取决于冠脉狭窄程度 ,还与粥样斑块病理学稳定性破坏有关     

地尔硫治疗冠状动脉造影术前围手术期不稳定型心绞痛临床研究

目的探讨地尔硫治疗冠状动脉造影前围手术期心绞痛的临床疗效和安全性。方法对106例围手术期心绞痛患者静脉应用地尔硫,观察心绞痛发作次数、血压、心率和心肌耗氧指数的变化,判断疗效。结果82例(77.4%)用药期间未再发作,另有24例(22.6%)仍有心绞痛发作,但程度减轻。用药1、24和48h时心率、收缩压、舒张压和心肌耗氧指数与用药前相比均下降(均P<0.05)。无一例因严重不良反应而停药。结论静脉应用地尔硫卓治疗冠状动脉造影前围手术期不稳定型心绞痛安全、有效。     

地尔硫(艹卓)治疗冠状动脉造影术前围手术期不稳定型心绞痛临床研究

目的 探讨地尔硫[艹卓]治疗冠状动脉造影前围手术期心绞痛的临床疗效和安全性。方法 对106例围手术期心绞痛患者静脉应用地尔硫[艹卓]，观察心绞痛发作次数、血压、心率和心肌耗氧指数的变化，判断疗效。结果 82例（77．4％）用药期间未再发作，另有24例（22．6％）仍有心绞痛发作，但程度减轻。用药1、24和48h时心率、收缩压、舒张压和心肌耗氧指数与用药前相比均下降（均P〈0．05）。无一例因严重不良反应而停药。结论 静脉应用地尔硫[艹卓]治疗冠状动脉造影前围手术期不稳定型心绞痛安全、有效。