运动试验恢复期ST段压低的原因和特点

平板运动负荷试验（运动试验）目的是通过逐级增加运动量，检测冠脉储备能力，诱发心肌缺血。狭窄的冠脉不能随着运动量的增加而相应扩张，供血、供氧不能满足心肌需要时即出现缺血性胸痛和缺血型ST段改变，通常发生在运动中心率的峰值阶段。而我们工作中发现部分患缺血型ST段压低不是出现在运动中心率最快时，而是出现在运动试验恢复期，即运动停止以后。为分析判断运动试验恢复期缺血型ST段改变对冠心病的诊断价值。作将运动试验恢复期缺血型卵段压低的临床资料进行分析对比，旨在发现运动前和运动试验恢复期ST段压低的特点、原因和心脏超声的改变对冠心病的诊断价值。     

平板运动试验中单纯恢复期ST段压低对冠心病的诊断价值及其临床特点

目的探讨平板运动试验中单纯恢复期ST段压低对冠心病的诊断价值及其临床特点。方法回顾性入选176例平板运动试验阳性的患者,根据其ST段压低出现时间将其分为运动期ST段压低组(n=140)和恢复期ST段压低组(n=36),比较其临床资料及冠状动脉造影结果。结果两组患者一般临床特点(如性别、年龄)无差异。恢复期ST段压低组的冠状动脉造影阳性率与运动期ST段压低组无统计学差异(55.7%vs.61.1%,P=0.348)。但恢复期ST段压低组前降支累及率更高(100%vs.83.3%,P=0.031)。与运动期ST段压低患者相比,恢复期ST段压低患者峰值SBP水平更高[(165±23)mm Hg vs.(177±17)mm Hg,P=0.010],提前终止试验的比例更低(31.4%vs.11.1%,P=0.003),运动时间更短[(416±146)s vs.(337±144)s,P=0.003]以及ST段压低持续时间更短[462(120~1 114)s vs.294(120~831)s,P=0.029]。结论诊断冠心病方面,平板运动试验中单纯恢复期ST段压低与运动期出现的ST段压低具有同等重要的价值。恢复期ST段压低患者中前降支病变的比例更高。而恢复期ST段压低患者的年龄、性别与运动期ST段压低的患者无差别。     

飞行员平板运动试验恢复期ST段压低特点和原因分析

目的探讨平板运动试验恢复期出现ST段压低的特点和原因。方法分析17例飞行员平板运动试验恢复期ST段压低的形态、持续时间以及同导联P波振幅、P-R段和体检鉴定资料,并与同期102例飞行员运动试验阴性者比较。结果恢复期ST段压低者以Ⅱ、Ⅲ、aVF导联多见,占82.4%(14/17);ST段压低在0.10～0.22 mV,平均(0.15±0.04)mV,ST段压低以Ⅲ导联最为显著;ST段压低持续时间2～5 min,平均(3.6±1.0)min,多在4 min内恢复正常,占76.5%(13/17);ST段多呈J点型压低,占82.4%(14/17),其中15例(88.2%)伴P-R段下斜型压低;恢复期ST段压低者,P波振幅在运动终点、运动后3 min以及运动后6 min均明显高于对照组(P＜0.01)。结论运动试验恢复期出现短暂性J点型ST段压低可能与心房复极向量增大有关,应注意结合同导联P波振幅和P-R段形态与病理性ST改变鉴别。     

急性心肌梗塞远隔导联ST段压低的临床意义

急性心肌梗塞特别是急性Q波心肌梗塞常伴有远隔导联ST段压低,据文献报告,其发生率可达48～100%.然而关于其临床意义及发生机制却争论颇多.本文对此作一综述.一、急性心肌梗塞时远隔导联ST段压低对预后的影响急性心肌梗塞远隔部位ST段压低时,急性下壁梗塞的发生率高于急性前壁梗塞的发生率.故对急性下壁心肌梗塞合并心前导联ST段压低的研究报告较多.Goldberg等发现急性下壁心肌梗塞合并V_1-V_4ST段压低者,其左室射血分数明显低于无ST段压低者.Salcedo等报告,下壁梗塞     

平板运动试验ST段压低出现时间段的临床意义

平板运动试验是目前诊断冠心病并判断其预后的常用辅助方法之一。采用多导联心电监测对236例平板运动试验阳性患进行冠状动脉造影结果对照，旨在探讨平板运动试验阳性患ST段压低出现时间段与冠状动脉造影阳性符合率的关系。     

对应性ST段压低在AMI早期鉴别诊断中的价值：附44例首次心电图ST段…

本文通过４４便首次心电图ＳＴ段抬高的分析，发现心电图有ＳＴ段抬高伴或不伴有异常Ｑ波，虽然常见于急性心肌梗塞（占８０％），也可见于非急性心肌梗塞的某些疾病（占２０％）。同时表明急性心肌梗塞，心电图并非都具有特征性的ＳＴ段弓背向上抬高，而非急性心肌梗塞病人的心电图也可有ＳＴ段弓背向上抬高的改变。两者除了在年龄，临床表现等方面可以区别外，心电图如有对应性ＳＴ段压低时，将有助于急性心肌梗塞的诊断。     

心电图运动试验中R波振幅变化与ST段压低的比较对冠心病的诊断意义

心电图运动负荷试验（ECG exercisetest）是发现早期冠心病的一种检侧方法,心电图运动试验的指征为：成人胸痛（尤其症状不典型者）的诊断;对确诊为冠心病患者,评价其病变程度及预后;评价心脏手术及药物的疗效;评价心肌梗死后病人的预后及如何进行康复训练。     

ST段指数标准在运动试验中检测的准确性

本文通过64例踏车运动试验,用统一标准与指数标准两种方法检测ST段改变,以彩色多谱勒图为参照,进行对比分析,报告如下。     

研究心电图ST段压低对急性ST段抬高型心肌梗死患者的预后价值

目的:分析心电图ST段压低对急性ST段抬高型心肌梗死(STEMI)患者的预后价值。方法:以我院心电图室2017年1月—2018年1月检测的1500例STEMI患者为观察对象,将心电图中出现ST段压低的604例患者设为研究组,将其余896例未出现ST段压低的患者设为对照组,分析两组预后价值。结果:研究组中急性下壁心肌梗死相比对照组更加常见,研究组收缩压、左室射血分数均低于对照组(P<0.05),但ST段太高、压低程度,肌钙蛋白I,并发症及病死率明显高于对照组(P<0.05)。结论:STEMI患者血液流动动力学状态极不稳定,预后较差,通过心电图及血液检验等检查方式可有效诊断患者病程程度,以便及时提供治疗方案,临床效果显著。     

Angina and ST-segment depression during treadmill and arm ergometer testing in patients with coronary artery disease

The clinical use of exercise rehabilitation programs has increased for patients with coronary artery disease. Exercise testing in these programs typically is conducted on a treadmill or cycle ergometer, although many patients' vocations require upper extremity activities and some patients cannot perform lower extremity exercises. To compare the hemodynamic responses and the incidence of angina and ST-segment depression during upper and lower extremity exercise in patients with coronary artery disease, we administered symptom-limited arm ergometer and submaximal or maximal symptom-limited treadmill tests to 95 cardiac rehabilitation patients who had completed an eight-week exercise training program. Treadmill testing resulted in significantly higher heart rates, systolic blood pressures, and double products than arm ergometer testing. The incidence of ST-segment depression was significantly greater with treadmill testing than with arm ergometer testing, but the incidence of angina was not different between tests. Ten patients had ST-segment depression during both arm ergometer and treadmill testing, and the double products at the onset of ST-segment depression were not different. Our data suggest that arm ergometer testing is less likely to result in ST-segment depression than treadmill testing in patients with coronary artery disease, possibly because of the lower hemodynamic responses during arm ergometer testing.     

Significance of ST depression during exercise treadmill stress and adenosine infusion myocardial perfusion imaging

Background: ST segment depression on the electrocardiogram during the exercise treadmill test (ETT) is used as a predictor of coronary artery disease (CAD), although it is recognised that both false-positive and false-negative results limit the value of this procedure. Although adenosine does not produce an inotropic or chronotropic effect upon the myocardium it may cause ST depression during infusion. Methods: The 12-lead ECG recordings obtained during 825 adenosine stress and 425 ETT procedures, performed as part of a 2-day Tc-MIBI protocol, were retained for examination and comparison with the appearances at subsequent myocardial perfusion imaging (MPI). Results: ST depression was associated with 44 (4.9%) of the adenosine stress and 44 (10.4%) of the ETT procedures. Both 1 and 2 mm ST depression during adenosine stress were significant predictors of reversible ischaemia (p < 0.01; p < 0.01). However, even though 2 mm ST depression on ETT was significant as a predictor of reversible ischaemia (p < 0.01), 1 mm ST depression on ETT was not (p = 0.4). There were more female cases with false positive ECG changes in both the adenosine stress (63.6%) group and the ETT (66.7%) group. There was no significant correlation between the territory of the ischaemic changes seen on the ECG with the location of defects developing on MPI in both the adenosine stress and ETT groups.Conclusions: ST depression of 1 mm occurring with adenosine stress, unlike with the ETT, is a significant predictor of ischaemia.     

Significance of ST-segment depression in inferior leads in patients with acute anterior infarction

Coronary arteriographic findings in patients with acute transmural anterior infarction were studied from 33 patients (30 men and 3 women). Their ages ranged from 28 to 76 years with a mean of 50 years. In 18 patients, ST depression of less than 1 mm in leads II, III and a VF was observed and these contributed to Group A. The remaining 15 patients in whom ST depression in these leads measured 1 mm or more formed Group B. All 33 patients had significant disease of the anterior descending branch of the left coronary artery but in Group A, only 5 (28%) had significant disease of either the right coronary artery (RCA) or the circumflex (CIRC) branch of the left coronary artery (or both) whereas these added lesions were noted in 12 (80%) of the patients in Group B. This was a significant difference (p less than 0.01). The mean peak plasma creatinine phosphokinase (IU/L) in Group B (2475 +/- 1111 S.D.) was greater (p less than 0.005) than in Group A (1147 +/- 998). The mean ejection fraction of 62.6 +/- 14.1% in Group A was higher (p less than 0.001) than that in Group B (40.3 +/- 13%). There was no relation between the duration of ST-segment depression in leads II, III and a VF and the presence of RCA/CIRC stenosis. Also, no correlation was noted between the presence of collateral circulation and the development of ST-segment depression.(ABSTRACT TRUNCATED AT 250 WORDS)     

Direct comparison of a contractility and activity pacemaker sensor during treadmill exercise testing

There are limited data about the chronotropic capacity of the peak endocardial acceleration (PEA) sensor. This study directly compared the chronotropic function from the PEA and the activity (ACT) sensor. The study included 18 patients (age 73 ± 7 years) with ≥ 75% pacemaker-driven heart rate (HR) and a PEA sensor and 11 healthy controls (age 67 ± 7 years) underwent a chronotropic assessment exercise protocol (CAEP) exercise test with the pacemaker patients in VVIR mode after programming the sensors in the default setting with adjustment of the upper sensor rate as an age related maximum value (220-age). The ACT sensor was externally strapped on the thorax. Achieved exercise duration for the patients and controls was, respectively, 9.2 ± 3 vs 18.4 ± 4 minutes (P < 0.001). The maximal achieved HR with the PEA sensor was 124 ± 25 beats/min, versus the ACT with 140 ± 23, versus the controls with 153 ± 26 beats/min (P < 0.001 between the groups). For the PEA, ACT, and controls, the time to peak HR was, respectively, 11 ± 3, 7 ± 3.6, and 18 ± 4 (P < 0.001 between groups) and HR after 10 minutes recovery was, respectively, 80 ± 20, 65 ± 15, and 82 ± 4 beats/min (P < 0.001 between groups). The PEA sensor functions hypochonotroop during exercise programmed as a single sensor system. It is, therefore, preferable to combine the PEA sensor with an activity-based sensor in a dual sensor system. Although both groups had normal left ventricular functions, the exercise capacity of pacemaker patients is significantly lower than in the controls.     

减重步行训练对缺血性脑卒中后抑郁患者疗效及生活质量的影响

目的 观察减重步行训练对缺血性脑卒中后抑郁障碍患者疗效及生活质量的影响。方法 共选取60例缺血性脑卒中后抑郁患者，将其随机分为训练组和对照组（每组30例）。对照组每天给予神经内科药物治疗及常规康复锻炼，训练组在此基础上辅以减重步行训练。2组患者治疗前、后分别采用改良爱丁堡-斯堪的那维亚评分标准（MESSS）评定其神经功能缺损程度，采用汉密尔顿抑郁量表（HAMD）进行抑郁程度评分，采用Fugl-Meyer评分（FMA）及Barthel指数（BI）评定其步行、平衡能力及ADL水平。结果 2组患者分别经4周治疗后，其MESSS、HAMD、FMA及BI评分等均较治疗前有明显改善；治疗后2组间比较，训练组各项指标改善程度均明显优于对照组，差异均有统计学意义（P〈0．05）。结论 对缺血性脑卒中后抑郁症患者尽早实施减重步行训练，町以显著改善患者的抑郁症状、步行、平衡及ADL功能，使其生活质量进一步提高。     

Comparison of isocapnic hyperventilation and treadmill exercise in children with exercise-induced asthma

The degree of post-exercise airway obstruction (Exercise-Induced Asthma (EIA] in 14 children was compared to the degree of airway obstruction following isocapnic hyperventilation. EIA was provoked by 6 min of treadmill running. Isocapnic hyperventilation was performed sitting during 6 min. The total ventilation (Vtot) during the two provocations was identical. The temperature of the inspired air was also identical during the two provocations, and the relative humidity was 40% during treadmill-running and 15% during hyperventilation. The decrease in peak expiratory flow after treadmill-running was 29%. After hyperventilation a fall on 19% was seen. These figures are statistically different. It is concluded that although there is a significant difference in airway obstruction after the two provocations the ventilation is greater importance for EIA than is the work load.     

Psycho-social dysfunctions in patients after recovery from mania and depression

Contrary to popular opinion, complete functional recovery does not occur in approximately 25% of patients with a diagnosis of mood disorders. The current study aimed at finding the recovery status in major mood disorders. A sample group of 122 patients (77 bipolar and 45 major depression) was selected from the outpatient department, fulfilling the DSM-IV diagnostic criteria. All patients had their index episodes at least one year prior to their date of inclusion and were either asymptomatic or mildly symptomatic during that time. Manics and depressives were rated with the Bech Raefelson Mania Scale (BRMS) and Hamilton Depression Rating Scale (HDRS) respectively. All the patients were also rated on the Brief Psychiatric Rating Scale (BPRS), Dysfunction Analysis Questionnaire (DAQ) and Global Evaluation Scale of Disability Assessment Schedule by WHO (GES/DAS). They were compared with 40 age and sex matched normal controls. It was found that the symptomatic recovery was better than the functional recovery in both manics and depressives and patients with major depression were marginally more dysfunctional compared to those with mania. It is concluded that a majority of patients of both mania and depression do not achieve complete functional recovery and are in need of on-going psychosocial rehabilitation.     

Effect of Acu-TENS on recovery heart rate after treadmill running exercise in subjects with normal health

OBJECTIVE: This study aims to investigate the effect of transcutaneous electrical nerve stimulation, applied at bilateral acupuncture points PC6 (Acu-TENS), on recovery heart rate (HR) in healthy subjects after treadmill running exercise. DESIGN: A single blinded, randomized controlled trial. SETTING: Laboratory with healthy male subjects (n=28). INTERVENTIONS: Each subject participated in three separate protocols in random order. PROTOCOL A: The subject followed the Bruce protocol and ran on a treadmill until their HR reached 70% of their maximum (220-age). At this 'target' HR, the subject adopted the supine position and Acu-TENS to bilateral PC6 was commenced. PROTOCOL B: Identical to protocol A except that Acu-TENS was applied in the supine position for 45min prior to, but not after exercise. PROTOCOL C: Identical to protocol A except that placebo Acu-TENS was applied. MAIN OUTCOME MEASURES: Heart rate was recorded before and at 30s intervals after exercise until it returned to the pre-exercise baseline. The time for HR to return to baseline was compared for each protocol. RESULTS: Acu-TENS applied to bilateral PC6 resulted in a faster return to pre-exercise HR compared to placebo. Time required for HR to return to pre-exercise level in protocols A-C was 5.5+/-3.0; 4.8+/-3.3; 9.4+/-3.7 min, respectively (p<0.001). There was no statistical difference in HR recovery time between protocols A and B. Subjects expressed the lowest rate of perceived exertion score (RPE) at 70% maximum HR with protocol B. CONCLUSION: This study suggests that Acu-TENS applied to PC6 may facilitate HR recovery after high intensity treadmill exercise.     

Respiratory gas exchange during treadmill exercise testing: reproducibility and comparison of different exercise protocols.

Ten subjects performed 4 maximal exercise tests to evaluate reproducibility and effects of treadmill inclination on submaximal and maximal oxygen consumption. They performed a standard Bruce protocol twice, and 1 protocol with progressive speed increase with constant, or without, inclination. At maximal exercise there was no significant difference between the protocols in oxygen consumption, respiratory gas exchange ratio, minute ventilation, plasma lactate, serum potassium or heart rate. Exercise time and treadmill distance were shorter than Bruce protocol with inclination, and considerably prolonged without. Reproducibility for Bruce protocol was good for group comparison of oxygen consumption throughout exercise. The individual variations for oxygen consumption were small at maximal exercise, but were considerable at rest and at the lowest exercise steps, this was slightly improved by analysing longer sampling time. Thus, measurement of oxygen consumption is reliable for group analysis, but interpretation must be careful in individuals unless maximal exercise is obtained. Treadmill inclination may be adjusted according to individual preferences.