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心肌缺血时会出现心绞痛、心电图上ST段改变和产生无氧代谢的终末产物。其中以胸痛的可靠性最小,因为:(1)心肌梗死可无疼痛;(2)无症状病人极量活动踏板运动试验后ST段可压低,这些病人中的相当一部分在2.5年内将有冠状动脉疾病的临床表现;(3)心绞痛病人施行心房调搏可引起ST段改变而无胸痛;(4)变异型心绞痛病人无论有无胸痛均可出现ST段抬高。应激试验阳性的多数心绞痛病人,经活动时心电图监视常发现一时性无痛性ST段压低。一时性ST段压低在不伴胸痛者比伴有胸痛者持续时间短,心率较慢,而ST段压低程度无差异,疼痛与病人活动亦无关。这提示,病人心肌缺血程度可不同,程度轻者可为“无痛性”。
Angina pectoris occurs during myocardial ischemia, ST segment changes on the electrocardiogram, and end products that produce anaerobic metabolism. Among them, the reliability of chest pain is the smallest, because: (1) myocardial infarction may be painless; (2) asymptomatic patients with extreme activities treadmill exercise ST-segment depression can be, a considerable portion of these patients within 2.5 years will have coronary arteries (3) Atrial pacing in patients with angina pectoris can cause ST segment changes without chest pain; (4) Patients with variant angina pectoris may have ST segment elevation with or without chest pain. Stress test positive for most patients with angina, ECG activity often found when the temporary painless ST segment depression. Temporary ST-segment depression in patients without chest pain than chest pain associated with short duration, slow heart rate, ST-segment depression was no difference in pain and patient activity has nothing to do. This suggests that patients with different degrees of myocardial ischemia, the degree of light may be “painless.”