Roberts W C
Circulation. 1976 Sep;54(3):388-90. doi: 10.1161/01.cir.54.3.388.
Certain clinical and morphologic observations are described in 27 patients with severe isolated angina pectoris of either the stable (five patients) or the unstable form (22 patients). Twenty-four patients died during or shortly after cardiac operations designed to relieve angina pectoris and three died during cardiac catheterization. During life none had had clinical evidence of acute myocardial infarction or congestive cardiac failure. At necropsy, each had diffuse, extensive coronary atherosclerosis with severe luminal narrowing: the lumens of at least two, an average of three, of the four major epicardial coronary arteries were narrowed greater than 75% in cross-sectional area by old atherosclerotic plaques. Despite the severe coronary narrowing, there was little myocardial damage. Left ventricular scarring (excluding papillary muscle) was observed grossly in only 14 (52%) of the 27 patients and in each it involved only a small portion of myocardial wall. The left ventricular cavity was of normal size in all except two patients. The hearts were of normal weight in 15 (56%) patients, and the average increase above the upper range of normal for the other 12 hearts was 19%. Thus, clinically isolated, severe angina pectoris is associated with severe, diffuse luminal narrowing but relatively little myocardial damage.
本文描述了27例严重孤立性心绞痛患者的某些临床和形态学观察结果，其中稳定型心绞痛患者5例，不稳定型心绞痛患者22例。24例患者在旨在缓解心绞痛的心脏手术期间或术后不久死亡，3例在心脏导管检查期间死亡。生前均无急性心肌梗死或充血性心力衰竭的临床证据。尸检时，每例患者均有弥漫性、广泛性冠状动脉粥样硬化，伴有严重的管腔狭窄：四条主要心外膜冠状动脉中至少两条（平均三条）的管腔被陈旧性动脉粥样硬化斑块在横截面积上狭窄超过75%。尽管冠状动脉严重狭窄，但心肌损伤却很少。27例患者中仅有14例（52%）肉眼观察到左心室瘢痕形成（不包括乳头肌），且每例仅累及心肌壁的一小部分。除2例患者外，其余患者左心室腔大小正常。15例（56%）患者心脏重量正常，其余12例心脏平均比正常上限增加19%。因此，临床上孤立的严重心绞痛与严重的弥漫性管腔狭窄相关，但心肌损伤相对较少。
