Ginghina Carmen, Ungureanu Catalina, Vladaia Aurora, Popescu B A, Jurcut Ruxandra
"Prof. Dr. C.C. Iliescu" Institute of Cardiovascular Diseases, Bucharest Fundeni 258, Bucharest, Romania.
J Med Life. 2009 Jan-Mar;2(1):80-91.
Angina pectoris is a common disabling disorder and a clinical syndrome, caused by myocardial ischemia; an imbalance between myocardial oxygen supply and myocardial oxygen consumption. Thus, ischemia produces a typical series of events such as metabolic and biochemical alterations which lead to impaired ventricular relaxation and diastolic dysfunction, impaired systolic function, and electrocardiographic abnormalities and painful symptoms of angina. Transmembrane ionic currents are responsible for the cardiac potentials that are recorded as the electrocardiogram (ECG). The electrocardiographic profile of patients with angina pectoris is variate. The electrocardiogram provides critical information for both diagnosis and prognosis, particularly when a tracing is obtained during the episodes of pain. A completely normal electrocardiogram does not exclude the possibility of acute coronary syndrome. Serial ECG tracings improve the clinician's ability to diagnose acute and chronic coronary syndromes. The ECG may assist in clarifying the differential diagnosis if taken in the presence of pain. The resting ECG also has an important role in risk stratification. Exercise ECG is more sensitive and specific than the resting ECG as far as myocardial ischemia detection is concerned, and it represents the test of choice which helps identifying inducible ischemia in the majority of patients suspected of stable angina.
心绞痛是一种常见的致残性疾病和临床综合征，由心肌缺血引起，即心肌氧供与心肌氧耗之间的失衡。因此，缺血会引发一系列典型事件，如代谢和生化改变，进而导致心室舒张功能受损和舒张功能障碍、收缩功能受损、心电图异常以及心绞痛的疼痛症状。跨膜离子电流负责产生可记录为心电图（ECG）的心脏电位。心绞痛患者的心电图表现各异。心电图为诊断和预后提供关键信息，尤其是在疼痛发作期间进行记录时。完全正常的心电图并不能排除急性冠状动脉综合征的可能性。系列心电图记录可提高临床医生诊断急性和慢性冠状动脉综合征的能力。如果在疼痛发作时进行心电图检查，有助于明确鉴别诊断。静息心电图在风险分层中也具有重要作用。就心肌缺血检测而言，运动心电图比静息心电图更敏感、更具特异性，它是大多数疑似稳定型心绞痛患者中有助于识别诱发性缺血的首选检查。
