42例老年冠心病临床与病理对比分析

A Clinical and Pathological Analyses of 42 Cases of Coronary Heart Disease in the Elderly

对比分析42例老年冠心病的临床与病理资料。结果表明:心电图对心肌缺血的诊断符合率为79.0％,对心肌肥厚的诊断符合率为52.0％。其中31例血脂增高者以甘油三酯更明显。血脂水平与冠状动脉阻塞程度无关。伴有高血压组的心脏重量、左室后壁厚度明显高于非高血压组。多数病人的临床表现与冠脉关系密切,但也有冠脉几乎阻塞而缺乏临床症状者。8例170岁以上心肌梗塞患者的临床及病理特点为:冠脉受累支数多,冠脉阻塞以环形狭窄为主,多伴有斑块出血,可无心绞痛,易伴意识丧失,并发症较多,易发生猝死。

Fourty-two cases with coronary heart disease in the elderly were analysed clinically and pathologically. The results showed : (1) The rate of correct diagnosis of myocardial hypertrophy on ECG was 52. 0%, that of myocardial ischemia was 79. 0%. The more severe coronary arteries involved, the more apparent myocardial ischemia became. Coronary artery changes were mild among the patients with normal ECG. (2) 73. 8% of cases had hyperlipi-demia, but the level of serum cholosterol was not associated with the extent of coronary artery change. The heart weight and the thinkness of ventricular wall of cases with hypertension were apparently higher than that of those cases with out hypertension. (3) Clinical manifestations of the most cases were associated with coronary artery change, but there were a few cases with severe coronary artery changes without any symptom. Clinical and pathological characteristics of acute myocardial infarction in the elderly were discussed.