老年冠心病患者心绞痛发作的等同表现形式

Angina equivalents of coronary heart disease in the elderly

目的探讨老年冠心病心绞痛发作的等同表现形式及其诊治对策，并提出引起临床重视。方法报道８例经选择性冠状动脉造影和心电图证实的典型老年病例。结果全部患者心绞痛发作时从无心前区疼痛，而是表现为心脏性呼吸困难、极度衰弱感、肺水肿和运动试验时疲乏、气急、低血压反应等临床等同症状和体征。冠状动脉造影显示均为多支血管病变。６例采用经皮冠状动脉造影术和支架植入术，症状缓解，平均随访２０６个月，病情均未再复发。结论心绞痛的等同症状在老年人并不少见，应特别注意其鉴别诊断及处理措施，冠状动脉介入性治疗是本症的重要方法之一。

Objective To study the characteristic and management of atypical angina pectoris in the aged patients. Methods 8 typical cases were reported whose average age was 66 8±7 2(62～81)years.They were diagnosed by coronary angiography and electrography. Results Typical chest pain didnt occur in these senile petients,but abrupt dyspnea,edema asthenia,fatigue and low blood pressure response during exercise testing and even pulmonary edema were found to be essential clinical manifestation,which was called angina equivalents.5 cases were cured by PTCA or stenting method,and angina equivalents hadnt recurred during a average 20 6 months of follow up. Conclusions Angina equivalents are not rarely found in the aged patients.The differential diagnosis can be made by careful objective checks.Interventional treatment is one of important therapy.