论文部分内容阅读
目的:探讨24h动态心电图监测对变异型心绞痛冠脉病变的诊断价值。方法:对29例确诊变异型心绞痛患者的动态心电图监测(DCG)和选择性冠状动脉造影(CAG)检查结果进行回顾性分析。结果:CAG检查示:23例有冠状动脉狭窄,其分布部位依次为左前降支13例,右冠状动脉7例和左回旋支3例,其中75%以上狭窄15例(65.5%)。DCG监测:ST段抬高时间与胸痛发作时间基本一致,ST段抬高并发各类型心律失常的有:室性心律失常14例,房性心律失常5例,心房纤颤1例,窦性停搏、房室传导阻滞及窦房传导阻滞5例,心室颤动1例。阵发性ST段抬高≥0.20mv者18例,其中狭窄程度≥75%者12例(66.7%),抬高最长持续时间≥3min者24例,其中狭窄程度≥75%者16例(75%)。结论:变异型心绞痛更易在冠状动脉狭窄病变的基础上发生冠脉痉挛,冠状动脉痉挛所致心律失常可能与ST段抬高的程度、持续时间呈正相关,而其类型与发生痉挛的血管部位有关。DCG可明显提高变异型心绞痛的诊断率。
Objective: To investigate the value of 24h ambulatory electrocardiogram monitoring in the diagnosis of coronary heart disease with variant angina pectoris. Methods: The results of dynamic electrocardiogram (DCG) and selective coronary angiography (CAG) in 29 patients with confirmed angina pectoris were analyzed retrospectively. Results: The CAG examination showed that there were 23 cases of coronary artery stenosis. The distribution of them was in the left anterior descending branch in 13 cases, in the right coronary artery in 7 cases and in the left circumflex artery in 3 cases. Among them, 15 cases (65.5%) were over 75%. DCG monitoring: ST elevation time consistent with the onset of chest pain, ST-segment elevation complicated by various types of arrhythmia are: ventricular arrhythmia in 14 cases, atrial arrhythmia in 5 cases, 1 case of atrial fibrillation, sinus arrest Stroke, atrioventricular block and sinoatrial block in 5 cases, 1 case of ventricular fibrillation. There were 18 cases of paroxysmal ST segment elevation ≥0.20mv, of which 12 cases (66.7%) had stenosis ≥75%, 24 cases had the longest duration ≥3min, including 16 cases with stenosis≥75% 75%). CONCLUSIONS: Variant angina pectoris is more likely to develop coronary spasm on the basis of coronary artery stenosis. Coronary artery spasm-induced arrhythmia may be positively correlated with the degree and duration of ST elevation, and its type is related to the vascular site of spasticity . DCG can significantly improve the diagnosis of variant angina.