40例变异型心绞痛的心电图分析

ANALYSIS OF THE ELECTROCARDIOGRAMS OF VARIANT ANGINA

本文对40例变异型心绞痛发作时和发作后的心电图进行了分析,提出国人冠状动脉痉挛的发生率左前降支最高,其次为右冠状动脉。运动可直接或通过运动后缺血诱发冠状动脉痉挛。变异型心绞痛发作后T波倒置是较常见的现象,其反复发作可导致缺血的叠加甚至急性心肌梗塞。

In order to further recognize the episodic characters of coronary spasm, the electrocardiograms of 40 patients with variant angina were studied. It was found that spasm most often occurred in the left anterior descending coronary artery and then the right coronary as judged by ST segment elevation during the attacks. Exercise test was performed in 14 patients, among them 6 had ST segment elevation associated with chest pain during exercise suggesting that exercise could provoke coronary spasm. One patient developed effort angina with persistent ST depression in leads Ⅱ, Ⅲ, aVF, Ⅴ_(1-4) during and after exercise and then had variant angina with elevated ST segment in leads Ⅴ_(1-3) two minutes after exercise. The result suggests that coronary spasm seems to be induced by isebemis. 21 of the 40 patients developed inversion of T waves in the leads of original ST segment elevation after relief of the attack, Only 9 of the 21 patients were diagnosed as acute subendocardial infarction according to the characters of inversed T waves and serum enzyme changes. The leads of elevated ST segment during anginal pain corresponded to the electrocardiographic location of AMI. These patients had frequent variant angina attacks before AMI, but each attack lasted for less than fifteen minutes in most of these patients, which indicates that this kind of AMI might be caused by accumulative ischemia.