运动试验期间无痛性心肌缺血诱发的危及生命的室性心动过速和心室颤动。

Life-threatening ventricular tachycardia and fibrillation induced by painless myocardial ischemia during exercise testing.

作者信息

Hong R A, Bhandari A K, McKay C R, Au P K, Rahimtoola S H

出版信息

JAMA. 1987 Apr 10;257(14):1937-40.

PMID:3820514

Abstract

The clinical importance of myocardial ischemia without associated symptoms in patients with atherosclerotic coronary disease has not been clarified. We present three patients in whom painless cardiac ischemia was associated with the induction of cardiac arrest and/or ventricular tachycardia/fibrillation. In the two surviving patients, programmed ventricular stimulation did not induce ventricular arrhythmias. In one patient, successful coronary bypass surgery resulted in the elimination of exercise-induced painless myocardial ischemia and associated ventricular fibrillation; the other patient suffered a myocardial infarction after which ischemia and ventricular tachyarrhythmias could not be reproduced with exercise testing. We conclude that painless myocardial ischemia can cause life-threatening arrhythmias and is, therefore, a potentially lethal phenomenon.

摘要

在动脉粥样硬化性冠状动脉疾病患者中，无症状心肌缺血的临床重要性尚未明确。我们报告了3例患者，其无痛性心脏缺血与心脏骤停和/或室性心动过速/心室颤动的诱发有关。在2例存活患者中，程控心室刺激未诱发出室性心律失常。1例患者成功进行冠状动脉搭桥手术后，运动诱发的无痛性心肌缺血及相关心室颤动消失；另1例患者发生心肌梗死后，运动试验无法再诱发缺血和室性快速心律失常。我们得出结论，无痛性心肌缺血可导致危及生命的心律失常，因此是一种潜在的致命现象。