高血压病患者ST-T改变与冠心病关系的探讨

Study of the relationship between abnormal ST-T in electrocardiogram and coronary heart disease in patients with hypertension

目的 :探讨高血压病患者心电图有ST T改变 ,伴有不典型胸痛时冠心病的诊断。方法 :对70例心电图有ST T改变 ,伴有不典型胸痛的高血压病患者有关临床资料与冠脉造影结果进行回顾性分析。结果 :本文资料显示 ,70例高血压病患者心电图有ST T改变 ,伴有不典型胸痛时 ,冠脉造影证实有冠心病者占 40 % (2 8 70 ) ,且以单支和左前降支病变为主。 2例证实为心尖肥厚型心肌病。高血压病病程长、血压水平高者 ,2支、3支病变发生率高 ;相反 ,高血压病病程短 ,血压水平低者 ,冠状动脉无病变或冠脉病变轻。结论 :高血压病患者有ST T改变 ,伴有不典型胸痛时合并冠心病的比例较低 ,因此临床上仍应作冠脉造影 ,以明确冠心病诊断。而心电图巨大倒置T波应高度重视肥厚型心肌病诊断。本文资料显示冠状动脉病变程度与血压升高水平和病程有关 。

Objective:To probe the diagnosis of coronary heart disease in hypertension patients with abnormal ST T in electrocardiogram (ECG) and atypical chest pain.Method:The clinical data and coronary angiography(CAG) results of 70 hypertension patients with abnormal ST T and atypical chest pain were retrospectively analyzed.Result:Of the 70 cases,40%(28/70) were confirmed by CAG as with coronary heart disease and in most cases the involved branches were one branch and left anterior descending branch.Two cases were proved to be apex hypertrophic cardiomyopathy.ln patients with long history of hypertension and very high blood pressure the incidence of combined involvement of two or three coronary branches was more frequent,otherwise the coronary arteries were without abnormality or with only slight abnormality.Conclusion:CAG remains to be a necessary examination for the diagnosis of coronary heart disease in hypertension patients,because in most cases the abnormal ST T in ECG and atypical chest pain in hypertension patients do not predict the incidence of coronary heart disease.When T wave inversion in ECG was observed,close attention should be paid to the possibility of hypertrophic cardiomyopathy.The present study indicates that extent of coronary artery abnormality is associated with the blood pressure level and the duration of disease,which encourages the active prevention and treatment of hypertension to decrease the incidence of coronary heart disease. [