Börjesson M
Department of Medicine, Sahlgrenska University Hospital/Ostra, Göteborg, Sweden.
Herz. 1999 Apr;24(2):114-25. doi: 10.1007/BF03043850.
A substantial proportion of patients with chest pain referred to hospital, show signs of coronary artery disease. Anginal pain could be conceptualized as a warning signal for coronary artery disease and impending death. But, for many reasons this theory is partly disputed. Firstly, not all ischemic episodes are accompanied by anginal pain (silent ischemia). Secondly, chest pain indistinguishable from true angina pectoris may be the result of other abnormalities of thoracic viscera. Nevertheless acute severe cardiac ischemia often gives rise to anginal chest pain. Unstable angina pectoris is carrying a higher risk for future events in spite of intensive medical treatment. A special problem are patients awaiting coronary intervention because of severe ischemia and maximum medical treatment, who experience ischemic pain. New treatment regimens are needed for these patients. This review discusses the symptom of visceral pain from the heart, angina pectoris, its relation to ischemia and unstable angina pectoris. It also addresses the role of afferent nerve stimulation (transcutaneous electrical nerve stimulation, TENS) in the treatment of severe angina pectoris as well as recent findings of TENS applicability in unstable angina.
被转诊至医院的胸痛患者中，相当一部分显示出冠状动脉疾病的迹象。心绞痛可被视为冠状动脉疾病和即将死亡的警示信号。但是，由于多种原因，这一理论存在部分争议。首先，并非所有缺血发作都伴有心绞痛（无症状性缺血）。其次，与真正的心绞痛难以区分的胸痛可能是胸部内脏其他异常的结果。然而，急性严重心脏缺血常引发心绞痛性胸痛。尽管进行了强化药物治疗，不稳定型心绞痛仍对未来事件构成更高风险。一个特殊问题是因严重缺血且接受最大程度药物治疗而等待冠状动脉介入治疗的患者会经历缺血性疼痛。这些患者需要新的治疗方案。本综述讨论了心脏内脏痛的症状——心绞痛，其与缺血及不稳定型心绞痛的关系。它还探讨了传入神经刺激（经皮电刺激神经疗法，TENS）在严重心绞痛治疗中的作用以及TENS在不稳定型心绞痛中适用性的最新研究结果。
