动态心电图监测老年冠心病无症状心肌缺血的意义

Significance of Holter monitoring silent myocardial ischemia in elderly patients with coronary artery disease

目的:探讨24小时动态心电图(Holter)对老年冠心病患者无症状心肌缺血(SMI)的检出情况。方法:回顾分析我院门诊及住院336例老年冠心病患者的临床情况和Holter资料。结果:(1)常规心电图检出心肌缺血106例(31.55％),Holter检出心肌缺血220例(65.48％);SMI发生率为69.09％,有症状心肌缺血发生率为30.91％;(2)SMI发作有明显生物节律,以清晨6-12时发作频率最高;(3)SMI发作时心率减慢的比例明显低于有症状心肌缺血的(P<0.005);(4)SMI的心律失常检出率为93.4％。结论:Holter可早期发现老年人的无症状心肌缺血,有重要价值。

Objective: To evaluate the clinical significance of Holter monitoring silent myocardial ischemia (SMI) in elderly patients with coronary artery disease (CAD). Methods: The clinical and Holter monitoring data of 336 in-patients were retrospectively analyzed. Results:(1) Myocardial ischemia had been detected by routine electrocardiographic record in 106 cases (31. 55%) , by Holter monitoring in 220 cases (65. 48%). Ischemia was silent in 69. 09% patients and ischemia was symptomatic in 30. 9% patients; (2) SMI had biology rhythm and its peak of incidence was in 6 Am to 12 Pm; (3) The ratio of reduction of heart rate in silent ischemia was less than those of symptomatic ischemia (P<0. 005); (4) The incidence of arrhythmia was 93. 4% in patients with SMI. Conclusion: Holter monitoring may early detect whether the elderly patients have arrhythmia and silent myocardial ischemia. It is useful for identification of CAD.