微血管性心绞痛的临床诊断和治疗(附21例临床报告)

目的　探讨微血管性心绞痛的诊断和治疗。方法　以心电图、超声心动图、平板运动试验、同位素心肌灌注显像、冠状动脉造影及左室造影等检查方法诊断２１ 例微血管性心绞痛。结果　静息心电图９ 例正常，１２ 例有缺血性ＳＴ－ Ｔ 改变，超声心动图２１ 例正常；心绞痛发作或运动时２１ 例ＳＴ 段压低≥１ｍ ｍ ；平板运动试验２１ 例阳性；１６ 例同位素心肌灌注显像心肌缺血；冠状动脉造影２１ 例正常，其中１５ 例行左室造影正常。结论　微血管性心绞痛是由于小冠状动脉扩张贮备降低或异常收缩而导致的心肌缺血。诊断需结合临床表现、平板运动试验等无创性检查及冠脉造影结果。对硝酸酯类和β受体阻滞剂效果好。临床预后良好。

Clinical diagnosis and treatment of microvascular angina pectoris.

Objective T o evaluate the clinical diagnosis and treatment of microvascular angina.Methods 21 cases with microvascular angina were studied by ECG,echocardiography,treadmill exercise test(TET),\ \{99m\}Tc-MIBI myocardial perfusion imaging,coronary arteriography(CAG)and left ventriculography.Results At rest status ECG were normal in 9 cases and showed ischemic ST-T changes in 12 cases;echocardiography normal in 21 cases;at angina attack or exercise ST segment depressed over 1mm in all 21 cases;myocardial perfusion imaging demonstrated myocardial ischemia in 16 cases;all patients revealed normal CAG and 15 cases revealed normal left ventriculograph.Conclusion Reduced vasodilator reserve or inappropriate vasoconstriction of the coronary microvessels are implicated as causes of microvascular angina.Diagnosis of microvascular angina should be combined with clinical features,noninvasive cardiac examinations and CAG.Nitrates and betablockers are effective in treating microvascular angina.The prognosis is good in the follow-up period.