心电图正常的冠状动脉造影阳性病例分析

Analysis of the positive coronary angiography of patients with normal electrocardiogram

目的探讨心电图正常的冠心病病人冠状动脉造影特点。方法有典型的心前区疼痛病史而心电图正常的病人进行诊断性冠状动脉造影,收集冠状动脉造影阳性(冠状动脉狭窄直径≥50%)的完整冠心病病例共88例,其中合并有高血压病40例,糖尿病36例,进行分析。结果88例病人冠状动脉造影共累及病变数487处。其中左主干(LM)13例13处,左前降支(LAD)74例150处,左回旋支(LCX)59例106处,右冠状动脉(RCA)63例112处,对角支49例56处,间隔支1例1处,钝缘支15例15处,锐缘支4例4处,左室后支6例7处,后降支18例22处,中间支1例1处,左前降支心肌桥2例2处(其中1例心肌桥收缩期100%闭塞);88例病人中100%闭塞病变18例(占20.5%),存在侧支循环22例(占25%);单支病变14例(占15.9%),以左前降支为多,占78.6%(11/14),双支病变28例(占31.8%),左前降支+右冠状动脉相对多,占46.4%(13/28),三支病变33例(其中1例为LCX合并RCA及中间支),占37.5%(33/88),且多合并有高血压病及糖尿病。左主干病变13例,占14.8%(13/88),其中左主干合并单支病变3例(占3.4%),左主干合并双支病变4例(占4.5%),左主干合并三支病变6例(占6.8%)。结论冠心病患者心电图正常的原因:病灶小、局限;病变狭窄程度轻;狭窄病变供血的心肌存在良好的侧支循环;冠状动脉存在广泛病变;心电图伪改善。因此,心电图与冠状动脉造影的不一致性提醒临床医师不应根据体表心电图无缺血改变而除外冠心病诊断。

Objective To discuss the Coronary angiography characteristics of the Coronary heart disease （CHD） with normal electrocardiogram. Methods Coronary angiography was done in typical angina syndrome patients with normal ECG. Positive （the stenosis of coronary artery≥50% ）in 88 patients,40 patients with hypertension and 36 patients with Diabete. Results There were 487 lesions in 88 patients. Among these patients, there were 18 cases with total occlusion,22 eases with collateral circulation. There was single vessel disease in 14 cases （15.9%）;double vessel diseases in 28 cases（31.8%）and triple vessel disease in 33 cases （37.5%）,left main（LM）artery disease in 13 cases（14.8%）,among these patients,LM＋ single vessel disease in 3 cases （3.4%）;LM＋double vessel disease in 4 cases （4.5%）and LM＋triple vessel disease in 6 cases （6.8%）,The multipal vessel disease is often combining with hypertension and diabetes. Conclusions The normal ECG can＇t deny the diagnosis of CHD,because the ECG and CAG are not coincidence. The patients with normal ECG may have multiple vessel disease.