Gottlieb S O
Department of Medicine, Francis Scott Key Medical Center, Johns Hopkins Medical Institutions, Baltimore, Maryland 21224.
Am J Cardiol. 1987 Dec 28;60(18):33J-38J. doi: 10.1016/0002-9149(87)90681-3.
The clinical syndrome of angina pectoris was accurately described over 200 years ago by Sir William Heberden. However, in recent years, we have learned that many episodes of myocardial ischemia occur that are not accompanied by symptoms of angina pectoris. These silent ischemic episodes may be detected either during exercise testing, using electrocardiographic criteria that can be combined with scintigraphic studies evaluating myocardial blood flow (thallium perfusion studies) or left ventricular function (gated blood pool scans). In addition, continuous electrocardiographic (Holter) monitoring can be used for the detection of transient ST-segment changes; these changes on Holter monitoring have been correlated with abnormalities of myocardial perfusion and function, indicating that they represent true ischemic events. Studies have shown that patients with coronary artery disease who have evidence of ongoing ischemia, whether symptomatic or silent, have an increased risk for experiencing subsequent cardiac events than patients without evidence of ischemia. Many studies have demonstrated that ischemia during an exercise study after myocardial infarction identifies patients at high risk for recurrent cardiac events, whether or not the ischemia is associated with angina pectoris. Holter monitoring has allowed for the detection of ischemic events out of hospital in ambulatory patients. Studies in stable angina patients have shown that there are many asymptomatic episodes in this setting, which are often occurring at low heart rates during activities of everyday life, without an apparent significant increase in myocardial oxygen demands, and these episodes may even be precipitated by mental stress.(ABSTRACT TRUNCATED AT 250 WORDS)
200多年前，威廉·赫伯登爵士就准确地描述了心绞痛的临床综合征。然而，近年来我们了解到，许多心肌缺血发作并无心绞痛症状。这些无症状缺血发作可在运动试验期间检测到，采用可与评估心肌血流的闪烁扫描研究（铊灌注研究）或左心室功能（门控血池扫描）相结合的心电图标准。此外，连续心电图（动态心电图）监测可用于检测短暂性ST段改变；动态心电图监测中的这些改变与心肌灌注和功能异常相关，表明它们代表真正的缺血事件。研究表明，有持续缺血证据的冠心病患者，无论有无症状，发生后续心脏事件的风险都高于无缺血证据的患者。许多研究表明，心肌梗死后运动研究期间的缺血可识别出复发性心脏事件的高危患者，无论缺血是否与心绞痛相关。动态心电图监测使我们能够在门诊患者的院外检测到缺血事件。对稳定型心绞痛患者的研究表明，在这种情况下有许多无症状发作，这些发作通常在日常生活活动期间心率较低时发生，心肌需氧量无明显显著增加，甚至可能由精神压力诱发。（摘要截选于250词）
