Selwyn A P, Shea M J, Deanfield J E, Wilson R A, deLandsheere C, Jones T
Am J Med. 1985 Sep 13;79(3A):12-7. doi: 10.1016/0002-9343(85)90488-7.
Transient ischemia arising from proximal events in epicardial coronary arteries causes important symptoms, such as angina pectoris, and is usually studied in the hospital with provocative tests. However, Holter monitoring of ST-segment disturbances in patients out of the hospital has shown frequent asymptomatic evidence of ischemia that is surprisingly prolonged and that is not associated with the obvious tachycardia of exercise or stress. Positron emission tomography has been developed to measure the regional myocardial uptake of a cation (rubidium-82) in order to assess repeatedly the directional changes in regional coronary blood flow during these events. This method has been used to show that both symptomatic and asymptomatic episodes of ST depression are reliably associated with disturbances in regional myocardial perfusion. The daily activities of patients have been analyzed and reproduced in the hospital to assess the effects of cold stimulation, mental arithmetic, cigarette smoking, and exercise. Physical exercise was associated with angina, ST-segment change, and regional abnormalities of myocardial perfusion, including decreased perfusion in poststenotic segments. The other tests caused the same disturbances in myocardial perfusion; these perfusion disturbances were mostly asymptomatic and surprisingly prolonged, with periods of recovery that were two to five times longer than the ST-segment disturbance and the pain. Current studies using a structured diary indicate that the episodes of transient ischemia occurring out of the hospital are more frequently associated with different levels of mental arousal than with any other activity. Physical exercise is a relatively infrequent cause of transient ischemia. The examination of coronary blood flow using provocative tests derived from the patients' own activities out of the hospital have confirmed that, irrespective of the pattern of angina, patients have frequent episodes of asymptomatic transient ischemia that are surprisingly prolonged and that these episodes occur in response to previously unsuspected ordinary daily activities. The disturbances in coronary blood flow usually include a regional decrease in myocardial perfusion that can only be explained by pathophysiologic events in the proximal epicardial coronary arteries.
源于心外膜冠状动脉近端事件的短暂性缺血会引发重要症状，如心绞痛，通常在医院通过激发试验进行研究。然而，院外患者动态心电图监测ST段紊乱显示，频繁出现无症状性缺血证据，其持续时间惊人地长，且与运动或应激时明显的心动过速无关。正电子发射断层扫描已被用于测量阳离子（铷 - 82）的局部心肌摄取，以便在这些事件期间反复评估局部冠状动脉血流的方向性变化。该方法已被用于表明，ST段压低的有症状和无症状发作均与局部心肌灌注紊乱可靠相关。已对患者的日常活动进行分析并在医院再现，以评估冷刺激、心算、吸烟和运动的影响。体育锻炼与心绞痛、ST段改变及心肌灌注局部异常有关，包括狭窄后节段灌注减少。其他测试也引起相同的心肌灌注紊乱；这些灌注紊乱大多无症状且持续时间惊人地长，恢复时间比ST段紊乱和疼痛长两到五倍。目前使用结构化日记的研究表明，院外发生的短暂性缺血发作更常与不同程度的精神兴奋相关，而非与任何其他活动相关。体育锻炼相对较少引发短暂性缺血。使用源于患者院外自身活动的激发试验检查冠状动脉血流已证实，无论心绞痛模式如何，患者频繁出现无症状性短暂性缺血发作，其持续时间惊人地长，且这些发作是对先前未被怀疑的日常普通活动的反应。冠状动脉血流紊乱通常包括局部心肌灌注减少，这只能用心外膜冠状动脉近端的病理生理事件来解释。
