心律失常患者48例冠状动脉造影结果分析

48例心律失常患者行冠脉造影,结果23例心律失常不伴典型心绞痛和心电图缺血改变者,冠状动脉阳性率13%;25例心律失常伴典型心绞痛和心电图缺血改变者,冠脉病变阳性率92.3%。前壁缺血的心电图预测左前降支病变敏感性为78.5%,特异性为91.6%,下壁缺血的心电图预测右冠脉病变敏感性为75%,特异性为75%。认为典型心绞痛和心肌缺血诊断冠心病较心律失常更为可靠。     

心律失常和心肌缺血与冠状动脉造影的临床对照研究

为了解不明原因心律失常与冠状动脉病变的关系，并探讨心电图心肌缺血部位与冠脉病变间的相关性，对４８例心律失常患者行冠状动脉造影。结果２２例心律失常不伴典型心绞痛和心电图缺血改变者，冠脉病变阳性率１３６％，２６例心律失常伴典型心绞痛和心电图缺血改变者，冠脉病变阳性率９２３％。前壁缺血的心电图预测左前降支病变敏感性７８５％，特异性９１６％，下壁缺血的心电图预测右冠脉病变敏感性７５％，特异性７５％。提示典型心绞痛和心肌缺血作为临床诊断冠心病较心律失常更为重要。     

心电图与冠状动脉造影诊断冠心病的临床分析

目的探讨心电图与冠状动脉造影对诊断冠心病的临床价值.方法观察575例临床诊断为冠心病的病人,均行18导联心电图(ECG)检查并行冠状动脉造影(CAG)检查.结果575例病人中有392例病人CAG阳性,临床符合率68.2%.ECG检查冠心病的灵敏度为76.9%,特异度为34.9%.心电图ST-T改变伴典型胸痛病人,CAG阳性率85.1%,心电图ST-T改变伴不典型胸痛病人,CAG阳性率43.3%,典型胸痛无心电图ST-T改变,CAG阳性率74.7%,不典型胸痛无心电图ST-T改变,CAG阳性率35.8%.结论典型胸痛伴心电图ST-T改变,对冠心病的诊断价值要优于不典型胸痛伴心电图ST-T改变,无心电图ST-T改变的典型胸痛病人不能排除冠心病,CAG检查可避免ECG检查对冠心病诊断造成的误诊、漏诊.     

47例胸痛伴心肌缺血患者冠状动脉造影结果分析

对47例胸痛伴心电图心肌缺血患者作冠状动脉造影,结果发现30例冠状动脉有狭窄或阻塞,与门诊急诊冠心病诊断的阳性符合率为64%,其中19例心肌梗塞组阳性率89%,17例心绞痛组为76%,而11例可疑心绞痛组仅为9%;31例平板运动试验与冠脉造影阳性符合率为60%.提示临床对胸痛伴心肌缺血者宜作冠状动脉造影以明确诊断,尤其对不典型胸痛和单纯以ST-改变者的冠状动脉造影更重要.     

中老年心律失常患者冠状动脉造影的临床分析

目的:分析心律失常患者冠状动脉造影(CAG)特点,以探讨其与冠脉病变的相关性。方法:回顾性分析60例心律失常患者冠状动脉造影的资料。结果:26例心律失常不伴典型心绞痛和心电图心肌缺血者,冠脉病变阳性率11.5％。34例心律失常伴典型心绞痛和心电图缺血改变者,冠脉病变阳性率91.1％;其中左前降支病变易发生快速性心律失常,右冠状动脉病变易发生缓慢性心律失常。两组冠脉造影阳性率有非常显著差异(P<0.01)。结论:心律失常伴典型心绞痛或心肌缺血者很可能是冠心病。     

心电图ST-T改变对冠心病的诊断价值

目的 通过对心电图ST-T改变与冠状动脉造影结果分析,探讨心电图ST-T改变在冠状动脉病变中的诊断意义.方法 对126例临床拟诊断冠心病患者的常规心电图资料与冠状动脉造影结果进行分析.结果 126例患者冠脉造影阳性91例,其中心电图ST-T改变35例;冠脉造影阴性35例,其中心电图ST-T改变19例.冠脉造影阳性患者40例单支病变中心电图ST-T改变16例,51例多支病变中心电图ST-T改变19例.结论 根据心电图ST-T改变诊断冠心病的假阴性和假阳性率高.     

拟诊冠心病患者临床诊断和冠状动脉造影检查的对照分析

目的通过总结在心内科进修期间笔者所管拟诊冠心病患者冠状动脉造影检查的结果,把患者的临床诊断和冠状动脉造影检查进行对照分析,探讨社区拟诊冠心病患者冠造检查的时机选择,提高笔者在社区基层工作中对冠心病的诊断水平。方法对临床拟诊冠心病患者142例常规进行冠脉选影,以一支或以上冠状动脉直径狭窄≥50%作为冠心病的诊断标准(冠造阳性)。结果所有患者经冠状动脉造影检查诊断为冠心病者105例,阳性率为74.0%,其中表现为典型心肌梗死症状者39例,阳性38例:表现为典型心绞痛胸痛者55例,阳性46例,不典型胸痛22例,阳性11例。存在危险因素患者冠造阳性率74%。心电图异常患者阳性率为93%。结论社区拟诊冠心病患者,伴有高龄、高血压、高血脂、糖尿病、吸烟、肥胖等危险因素,以及心电图异常,病状典型者冠脉阳性率高,要及时转往上级医院进行冠状动脉造影检查,早期诊断,及时治疗,提高患者生活质量及生存率。     

老年患者常规静息心电图ST-T改变与冠状动脉病变的临床探讨

目的 探讨老年患者静息心电图ST-T变化对冠心病的诊断价值.方法 对193例接受冠状动脉造影的非心肌梗死老年患者的心电图资料进行分析,与冠脉造影和超声心动图结果相比较.结果 经冠脉造影证实160例冠心病患者中心电图ST-T改变的阳性率仅59.37％,单支冠脉狭窄心电图阳性率56.66％,双支冠脉狭窄阳性率为60.41％...     

中年女性胸痛患者冠脉造影特点及其相关因素分析

目的了解女性胸痛与冠心病发病间的关系。方法选择40～60岁具有典型心绞痛或非典型心绞痛心电图有ST—T缺血性改变的女性患者76例进行冠状动脉造影（CAG）检查，并对胸痛症状、绝经年龄、出现胸痛症状距绝经时间、ST-T缺血性改变、配偶有无、血脂、血糖、高血压病史、CAG结果进行分析。结果76例胸痛患者中冠状动脉狭窄（CAS）组24例（占31．58％），冠状动脉正常（CAN）组52例（占68．42％）；CAS组与CAN组比较，高血压、无配偶、绝经期后、典型心绞痛症状、非典型心绞痛症状百分比以及血清Lp（a）水平差异均有统计学意义（P均〈0．05）。结论女性胸痛患者仅以症状及心电图变化作冠心病诊断误诊率较高，对疑诊冠心病患者应行CAG检查或冠脉造影CT筛查。     

冠心病心电图诊断与冠脉造影结果的对比研究

目的探讨有典型心前区疼痛和高血压史患者的心电图ST-T改变与冠状动脉造影结果的相关性。方法对80例有典型心前区疼痛史伴心电图ST-T改变,临床拟诊断冠心病患者的冠状动脉造影结果进行回顾性分析,其中男44例,女36例,年龄35～78岁。结果80例患者中冠状动脉造影阳性(冠状动脉狭窄直径≥50%)39例(48.75%),阴性41例(51.25%);冠心病组39例患者中,心电图ST-T改变29例(74.36%),非冠心病组41例患者中,心电图ST-T改变20例(48.78%)。结论临床依据心电图ST-T改变诊断冠心病应慎重。     

青年男性冠状动脉病临床与冠状动脉造影分析

目的 探讨青年男性（〈４０岁）心绞痛临床与冠状动脉造影（ＣＡＧ）的特点。方法 将９０例青年男性心绞痛患者按心肌梗塞（ＭＩ）（２０例）、典型心绞痛（３４例）、不典型心绞痛（３６例）分为三组并行ＣＡＧ。结果 有冠状动脉病变（ＣＡＤ）者４７例（５２．２％）。ＭＩ组１８例（９０％），典型组２２例（６４．７％），不典型组７例（１９．４％）。三组之间ＣＡＤ检出率比较有显著性差异，ＭＩ组〉典型组〉不典型组。冠脉     

Clinical presentation and prognosis of left main coronary artery disease in the 1980s

Clinical presentation and course were studied in 127 consecutive patients with angiographically proven left main coronary artery disease. Mean age was 62 (37-79) years. Thirteen patients (10%) had no history of chest pain, seven (5%) had atypical chest pain, and the remaining 107 (85%) typical angina pectoris. Eighty-two patients (65%) had unstable angina, 73 had suffered a myocardial infarction (MI) in the past, and 50 (68%) had post MI angina pectoris. The electrocardiogram was analysed in 102/125 patients during an episode of chest pain and also when they were without chest pain. Outside an episode of chest pain the ST segment was normal in 42 patients (32%), the T wave was normal in 50 patients (38%) and both the ST and T were normal in 33 patients (25%). During chest pain all patients had an abnormal ECG, the most frequent pattern being ST segment depression in leads V3, V4 and V5 (with maximal depression in V4), and ST segment elevation in leads V1 and aVR. The average number of leads with ST-T abnormalities was 6.4. A symptom-limited exercise test on a treadmill with 12-lead ECG monitoring was performed in 89 patients. The exercise test was abnormal in 88 patients (99%), most of whom (74 patients) were already in the first or second stage of the Bruce protocol. The most frequently observed abnormality was ST segment depression of 2 mm or more in leads V4, V5, and V6, and ST segment elevation in leads V1 and aVR. The systolic blood pressure during exercise fell or remained at the same level in 38 patients (43%).(ABSTRACT TRUNCATED AT 250 WORDS)     

非典型性冠状动脉痉挛患者的临床特点及近期预后

目的总结非典型性冠状动脉痉挛患者的临床特点。方法选择临床具有静息性胸痛或胸闷,且冠状动脉造影无显著狭窄的64例患者进行乙酰胆碱冠状动脉痉挛激发试验,将乙酰胆碱试验阳性即冠状动脉痉挛患者根据胸痛或胸闷发作时心电图上是否有ST段抬高分为典型变异型心绞痛组（典型组）和非典型变异型心绞痛性冠状动脉痉挛组（非典型组）,比较两组的临床症状特点（危险因素、心电图和核素心肌灌注显像负荷试验结果以及冠状动脉造影和乙酰胆碱试验的影像学）。结果共有46例（72％,46／64）患者诱发冠状动脉痉挛,其中典型组和非典型组分别为12及34例。典型组的平均年龄偏低（P〈0．05）,血脂代谢紊乱在非典型组更常见,运动心电图试验两组多为阴性,核素灌注心肌显像负荷试验两组均表现有反向再分布,冠状动脉造影典型组多为轻度局限性狭窄或节段性内膜不光滑,肌桥发生率更高,乙酰胆碱试验多诱发节段性痉挛。而非典型组为弥漫性血管细小、内膜不光滑、僵硬,血管迂曲伴远端血流缓慢,乙酰胆碱试验多诱发弥漫性血管痉挛,并可见多支血管同时痉挛。结论非典型性冠状动脉痉挛较典型变异型心绞痛更常见,且具有一定的特征性,应引起临床医生高度重视。     

胸痛特征诊断冠心病的准确性

目的 探讨胸痛特征诊断冠心病的准确性.方法 连续入组2012年6月至2016年6月经过冠状动脉造影(CAG)和冠状动脉血流储备分数(FFR)检查的住院患者240例,根据临床病史的描述将患者分成无胸痛组(55例),不典型胸痛组(79例),典型劳力心绞痛组(64例)和支架植入组(42例).将不同胸痛性质与CAG和FFR进行...     

Chest pain as a predictor of coronary artery disease in patients with obstructive aortic valve disease

To clarify the association between chest pain and significant coronary artery disease in patients who have aortic valve disease, 76 consecutive candidates for aortic valve replacement were evaluated prospectively with use of a historical questionnaire and coronary arteriography. Of the 76 patients, 19 (25 percent) had no chest pain, 21 (28 percent) had chest pain that was not-typical of angina pectoris and 36 (47 percent) had chest pain typical of angina pectoris. In 18 of 19 patients the absence of chest pain correlated with the absence of coronary artery disease. The single patient without chest pain who had coronary artery disease had evidence of an inferior myocardial infarction in the electrocardiogram. Thus, absence of chest pain and the absence of electrocardiographic evidence of infarction predicted the absence of coronary disease in all cases.

The presence of chest pain did not predict the presence of coronary artery disease, but the more typical the pain of angina pectoris the more likely were patients to have significant coronary artery disease. Of the 21 patients with atypical chest pain, 6 (29 percent) had coronary artery disease, but of the 36 patients with typical angina pectoris 23 (64 percent) had significant coronary artery disease. In addition, when patients with chest pain not typical of angina pectoris also had coronary artery disease, the diseased vessels usually supplied smaller areas of the left ventricle than when the pain was typical of angina pectoris. In 21 of 23 patients (91 percent) with typical angina pectoris and significant coronary artery disease, lesions were present in the left coronary artery. There was no systolic pressure gradient across the aortic valve that excluded the presence of coronary artery disease, although all patients with a calculated aortic valve area of less than 0.4 cm² were free of coronary artery disease. Patients with severe left ventricular dysfunction were more likely to have normal coronary arteries.     

体表心电图在冠心病诊断中的评价

目的探讨体表心电图在诊断冠心病方面的价值。方法对81例临床拟诊冠心病者的冠状动脉造影（CAG）结果和体表心电图进行回顾对比分析。结果 81例中,CAG阳性47例,阴性34例。冠心病组（A组）47例中,急性心肌梗死（AMI）15例,陈旧性心肌梗死2例,心绞痛22例,心电图ST-T改变18例,心电图正常8例。非冠心病组（B组）24例中,ST-T改变11例。结论体表心电图对心肌梗死（MI）诊断有重要价值。但是,临床依据心电图ST-T改变诊断冠心病应慎重。     

16排CT在评价胸痛患者冠状动脉病变中的应用价值

目的：探讨16排计算机断层扫描技术(CT)在评价胸痛疑似冠心病患者冠状动脉病变中的应用价值。方法：52例胸痛疑似冠心病患者人选,分别用16排CT造影方法(CTA)和常规冠状动脉造影方法(CAG)评价冠状动脉病变情况,并以CAG为标准计算CTA诊断冠状动脉病变的敏感度、特异度、阳性预测值(PPV)和阴性预测值(NPV)。结果：CTA能评价所有627个冠状动脉节段中的546个(87%)。在该546个冠状动脉节段中,CTA诊断冠状动脉病变的敏感度、特异度、PPV和NPV分别是94%、95%、82%和99%;CTA对冠状动脉左主干及其近中段病变的敏感度、特异度、PPV和NPV均高于冠状动脉远段和分支血管。结论：CTA能较准确地评价胸痛疑似冠心病患者冠状动脉(尤其是近、中段)的病变情况。     

冠脉痉挛与变异型心绞痛和急性心肌梗死的关系

目的 探讨冠脉痉挛与变异型心绞痛(VA)和急性心肌梗死(AMI)的关系。方法 对30例AMI和14例VA患者施行冠状动脉造影(CAG),以冠脉狭窄>50％为CAG阳性。结果 在30例AMI患者中有4例CAG正常,在14例VA中,CAG正常2例,狭窄程度在50％～90％的12例。结论 本文结果提示,冠脉痉挛在VA和AMI的发病中起着十分重要的作用。冠脉痉挛不仅可以发生在有严重狭窄的冠状动脉,亦可以发生于造影正常的冠状动脉。     

90例选择性冠状动脉造影分析

目的：探讨选择性冠状动脉造影在冠心病诊断及治疗中的价值。方法：对心肌梗塞、典型心绞痛、不典型心绞痛患者共90例进行选择性冠状动脉造影，并对结果进行分析。结果：冠脉造影阳性率：心肌梗塞组占100％，典型心绞痛组占79．2％，不典型心绞痛组占37．5％。心肌梗塞组及典型心绞痛组与不典型心绞痛组比较，冠脉造影阳性率差异非常显著（P〈0．01），心肌梗塞组与典型心绞痛组比较阳性率无显著差异（P〉0．05）。结论：冠状动脉造影不仅是诊断冠心病的“金标准”，而且有益于冠心病的分型和指导治疗。