运动诱发ST段抬高的临床意义

CLINICAL SIGNIFICANCE OF EXERCISE-INDUCED ST-SEGMENT ELEVATION

对５例运动诱发暂时性ＳＴ段抬高的原因及其与血管病变的关系进行分析，提出劳力型心绞痛患者运动诱发ＳＴ段抬高的临床意义不同于变异型心绞痛患者，对前者在近期内施行经皮冠状动脉腔内成形术（ＰＴＣＡ）是安全和有效的。运动诱发ＳＴ段抬高恢复正常后，相邻导联的ＳＴ段压低仍持续存在，提示其缺血相关血管有严重阻塞性病变。

Five patients developed ST-segment elevation during exercise testing were studied. All of them had extremely severe obstructive lesions in the left anterior descending artery.The causes of ST-segment elevation during exercise in those patient with variant angina(VA) or mixed angina is probably due to coronary artery spasm,and in those with effort angina(EA) may be caused by a combination of coronary artery constriction and speedy increase of myocardial oxygen consumption.Except the patient with VA,PTCA was successfully performed in four patients and their anginal attacks disappeared after PTCA,which suggests that PTCA is safe and effective in those patients developed ST-segment elevation during exercise.All patients had coexistent ST-segment depression in conjunction with ST-segment elevation during exercise testing.ST-segment depression normalized later than ST-segment elevation in them.The findings indicate that ST-segment depression in these cases do not represent a reciprocal image of the elevated ST-segment and may predict the presence of associated coronary disease.