冠状动脉痉挛的心电图改变及其临床意义

Change in electrocardiograph of coronary artery spasm and its clinical significance

目的 :通过对冠状动脉痉挛 (coronaryarteryspasm ,CAS)的心电图改变与临床特点的对照分析 ,重点探讨心电图改变及其临床意义。方法 :CAS的诊断是根据冠状动脉造影和 /或心绞痛发作时心电图记录到ST段抬高的典型改变。根据ST段抬高部位及冠脉造影情况 ,把CAS分为 3组 :左冠脉痉挛组、右冠脉痉挛组及未定型组。结果 :3 1例CAS患者中共检出心律失常 14例 (4 5 % ) ,其中左冠痉组 9例 ,右冠痉组 4例 ,未定型组 1例 ;发生意外心肌梗死 (Acutemyocardialinfarction ,AMI) 9例 (2 9% ) ,其中前壁 5例 ,下壁和 /或正后壁 4例 ;死亡 4例 (18% ) ,其中卒死 2例 ,泵衰竭 2例。结论 :①由CAS引起的变异型心绞痛发作 ,约有半数(4 5 % )可检出心律失常 ,左CAS以室性心律失常为主 ,右CAS以缓慢性心律失常为主 ;② 9例AMI中 ,7例记录到AMI发生部位与心绞痛发作时心电图显示ST抬高的部位相一致 ,提示导致心电图ST抬高与以后发生AMI系同一CAS所引起 ;③ 3 1例患者中死亡 4例 (18% ) ,皆为左冠痉组 ,表明左CAS引起缺血损伤面积大且较严重 ,预后较右CAS险恶。

Objective: To study the change in electrocardiograph(ECG)of coronary artery spasm(CAS)and its clinical significance by analyzing the change in ECG of CAS and related clinical charactersMethods: The diagnosis criteria of CAS is confirming by coronary angiography and/or ECG show ST segment elevation during CAS attack All patients were classified into 3 subgroups: left CAS groupright CAS group and unsettled group according to ECG and coronary angiographyResults: Among 31 patients, 14 were found having arrhythmia(45%)with 9 in left CAS group,4 in right CAS group,1 in unsettled group In addition, 9 were attacked by AMI(29%)with 5 in anterior wall,4 in inferior wall and/or posterior wall4 patients died(18%)with 2 of sudden death,2 of pump failureConclusion: ①During variant angina caused by CAS, almost half of patients(45%)were found having arrhythmia Left CAS domained in ventricular arrhythmia, right CAS domained in bradyarrhythmias②9 patients were attacked by AMI,7 patients were shown the same location in AMI as ST segment elevation in ECG of angina, which suggests that ST segment elevation in ECG and later AMI are caused by the same CAS③Among 31 patients,the 4 dead patients were all in left CAS group(18%),which suggests that myocardial ischaemia in left CAS is more serious and has a larger area than in right CAS Prognosis of left CAS is worse than of right CAS