Davies S W
Department of Cardiology, Royal Brompton Hospital, London, UK.
Br Med Bull. 2001;59:17-27. doi: 10.1093/bmb/59.1.17.
Angina pectoris is a clinical syndrome of discomfort in the chest, jaw, arm, or other sites which is associated with myocardial ischaemia. The nature of angina has many individual variations, and it is easier first to consider the typical syndrome. It is hard to better the descriptions of William Heberden: There is a disorder of the breast, marked with strong and peculiar symptoms, considerable for the danger belonging to it.... Those who are afflicted with it are seized, while they are walking, and more particularly when they walk soon after eating, with a painful and most disagreeable sensation in the breast.... the moment they stand still all this uneasiness vanishes. After it has continued some months, it will not cease so instantaneous upon standing still ... (most) whom I have seen, who are at least twenty, were men, and almost all above 50 years old, and most of them with a short neck, and inclining to be fat.... But the natural tendency of this illness be to kill the patients suddenly.... The os sterni is usually pointed to as the seat of this malady ... and sometimes there is with it a pain about the middle of the left arm. The usual cause of myocardial ischaemia is coronary atherosclerosis. Other diseases of the coronary arteries (emboli, spasm, vasculitis, Kawasaki disease, congenital anomalies), other cardiac diseases (hypertrophic cardiomyopathy, severe hypertension, severe aortic valve disease), and high output states (severe anaemia, thyrotoxicosis) are all uncommon or rare causes of angina. However, while angina is usually associated with atherosclerotic coronary artery disease, the converse is not always true. The condition of coronary atherosclerosis is very common (fatty streaks and more advanced plaques are almost universal in adults in industrialised countries) but it does not always cause myocardial ischaemia. Furthermore, myocardial ischaemia may present other than with angina - for each presentation there is a wide differential diagnosis.
心绞痛是一种胸部、颌部、手臂或其他部位不适的临床综合征，与心肌缺血相关。心绞痛的性质存在许多个体差异，首先考虑典型综合征较为容易。很难有比威廉·赫伯登描述得更好的了：有一种胸部疾病，伴有强烈且独特的症状，因其所具有的危险性而颇为严重……患有这种疾病的人在行走时，尤其是在进食后不久行走时，胸部会出现一种疼痛且极为不适的感觉……而一旦他们静止站立，所有这些不适就会消失。在持续数月之后，静止站立时它不会那么立刻停止……（我见过的）大多数患者至少20岁，是男性，几乎都超过50岁，而且他们大多脖子短，体型偏胖……但这种疾病的自然倾向是突然导致患者死亡……胸骨通常被认为是这种疾病的发病部位……有时左臂中部也会伴有疼痛。心肌缺血的常见病因是冠状动脉粥样硬化。冠状动脉的其他疾病（栓子、痉挛、血管炎、川崎病、先天性异常）、其他心脏疾病（肥厚型心肌病、重度高血压、重度主动脉瓣疾病）以及高输出状态（重度贫血、甲状腺毒症）都是心绞痛不常见或罕见的病因。然而，虽然心绞痛通常与动脉粥样硬化性冠状动脉疾病相关，但反之并不总是成立。冠状动脉粥样硬化的情况非常普遍（在工业化国家，脂肪条纹和更严重的斑块在成年人中几乎普遍存在），但它并不总是导致心肌缺血。此外，心肌缺血可能表现为非心绞痛的症状——对于每种表现都有广泛的鉴别诊断。
