Weiner D A
Can J Cardiol. 1986 Jul;Suppl A:180A-185A.
The pathophysiology of ischemic heart disease is multifaceted. Atherosclerosis, spasm, thrombosis, and embolism, alone and in combination, play a role in the pathogenesis of myocardial ischemia. The effect of coronary occlusive disease may vary from patient to patient, producing stable or unstable angina, or myocardial infarction. Myocardial ischemia occurs when there has been an acute imbalance between oxygen demand and supply. A number of variables alter the relationship between the presence of myocardial ischemia and the degree of coronary stenosis. These include the length, location, and geometry of the stenosis; the presence or absence of collateral vessels; and the coronary arterial tone. Coronary arteriography has shown the same general extent and distribution of coronary artery disease in patients with stable and unstable angina. Differences in the severity of coronary artery disease emerge when the various forms of unstable angina pectoris are considered separately. More severe coronary disease is present in patients who present with a crescendo pattern of angina and in those who display either ST-segment deviations or T-wave inversions during chest pain. The precise mechanism for the production of unstable angina in any individual patient is unknown but may be related to several factors, including the rapid progression of coronary artery disease just before or during the onset of unstable angina; or intermittent transient coronary artery occlusion resulting from spasm, platelet aggregation, or thrombosis.
缺血性心脏病的病理生理学是多方面的。动脉粥样硬化、痉挛、血栓形成和栓塞单独或共同作用于心肌缺血的发病机制。冠状动脉闭塞性疾病的影响在不同患者中可能有所不同，可导致稳定型或不稳定型心绞痛，或心肌梗死。当氧需求和供应之间出现急性失衡时，就会发生心肌缺血。许多变量会改变心肌缺血的存在与冠状动脉狭窄程度之间的关系。这些变量包括狭窄的长度、位置和形态；侧支血管的有无；以及冠状动脉张力。冠状动脉造影显示，稳定型和不稳定型心绞痛患者的冠状动脉疾病总体范围和分布相同。当分别考虑各种形式的不稳定型心绞痛时，冠状动脉疾病的严重程度会出现差异。表现为进行性加重型心绞痛的患者以及在胸痛期间出现ST段偏移或T波倒置的患者，冠状动脉疾病更为严重。任何个体患者发生不稳定型心绞痛的确切机制尚不清楚，但可能与多种因素有关，包括在不稳定型心绞痛发作前或发作期间冠状动脉疾病的快速进展；或由痉挛、血小板聚集或血栓形成导致的间歇性短暂冠状动脉闭塞。
