变异型心绞痛5例临床表现与冠脉造影的对照分析

Analysis of Clinical Manifestation and Coronary Angiography in 5 Patients with Variant Angina

目的探讨变异型心绞痛患者临床表现与冠脉病变的关系。方法对5例确诊为变异型心绞痛的患者行冠脉造影,将冠脉病变情况与临床表现作对比分析。结果(1)5例患者中,4例有冠脉狭窄病变(狭窄>80%),1例冠脉无狭窄病变,但有斑块。(2)5例患者心绞痛发作时,1例为胸前导联ST-T抬高性改变,冠脉造影为前降支狭窄病变。1例为不同发作时分别表现为胸前导联及下壁导联ST-T抬高性改变,冠脉造影为多支病变。1例发作时表现为胸前导联抬高性改变,冠脉造影未发现冠脉狭窄病变。2例发作时表现为下壁导联抬高性ST-T改变,冠脉造影均为左旋支中段狭窄。结论变异型心绞痛发作多发生在有狭窄病变基础上的冠脉,且发作时心电图ST-T抬高性改变的导联部位与其相关的冠脉痉挛有关。

Objective To approach the relationship of clinical manifestation and condition of coronary artery in patients with variant angina. Methods Routine coronary angiography was performed on 5 patients with defined variant angina. The condition of coronary artery and the clinical manifestation were contrasted and analysed. Results （1） Among five patients,four had coronary arterial stenosis and the extent of stenosis was more than 80% . One patient had coronary plaque without stenosis. （2）During variant angina attacking, one patient was single LAD stenosis with precordial leads ST-T rising changes. One patient who had precordial leads ST-T changes and inferior leads ST-T rising changes at different an- gina attacking was multiple-coronary artery stenosis. One case who had precordial leads ST-T rising changes had no coronary artery stenosis but coronary plaque. Two patients who had inferior leads ST-T rising changes were LCX stenosis. Conclusion （1） Variant angina often onsets in patients with coronary artery stenosis. （2） The leads with ST-T rising changes are relevant to the related coronary artery spasm.