病态窦房结综合征患者非典型性胸痛的临床意义

目的探讨病态窦房结综合征患者非典型性胸痛的病因及临床意义。方法 对34例临床诊断为病态窦房结综合征且需安装心脏永久起搏器、同时伴有非典型性胸痛的患者,在行心脏永久起搏器植入术的同时或术前和术后行冠状动脉造影术,分析冠状动脉病变及左心室功能,其中21例在冠状动脉造影时行乙酰胆碱试验。结果31例患者冠状动脉均正常或狭窄程度<50％,3例患者冠状动脉狡窄程度>75％,但在心动过缓患者可见冠状动脉血流速度明显缓慢。部分患者左心室明显扩大、左心室射血分数足室壁运动降低,9例乙酰胆碱试验阳性。无严重冠状动脉病变者多在起搏器植入术后或合并钙拮抗剂治疗后胸痛消失。结论 病态窦房结综合征患者的非典型性胸痛多数不具有严重冠状动脉病变基础,可能与心动过缓所导致的冠状动脉血流缓慢或冠状动脉痉挛有关,在安装起搏器和服用钙拮抗剂后胸痛多缓解。

The clinical significance of atypical chest pain in the patients with sick sinus syndrome

Objective To investigate the etiology and clinical significance of atypical chest pain in the patients with sick sinus syndrome (SSS).Methods Coronary angiography,left ventriculography and acetylcholine test were performed before and after implanting permanent pacemakers in the patients of SSS with atypical chest pain. Results Thirty-four patients were included in the study. Coronary angiography showed that the coronary arteries were normal or had light stenosis in 31 patients and significant stenosis in 3 patients, but coronary blood flow was significantly slow in those patients with bradycardia. Left ventricular enlargement, decreased ejection fraction and hypokinesis of left ventricle were noticeable in some patients. Coronary spasm was remarkable in nine of twenty-one patients who underwent acetylcholine test. Chest pain disappeared in most of the patients without significant coronary stenosis after pacemaker implantation or pacemaker plus calcium antagonists. Conclusions Atypical chest pain in patients with SSS might (?)elate to slow flow in coronary arteries induced by bradycardia or coronary spasm and usually did not indicate significant coronary stenosis, which might disappear or be alleviated by implanting pacemaker or pacemaker plus ealcium antagonists. Attention should be paid to differentiate between degeneration, coronary spasm and dilated myocardiopathy in these patients.