Miller A B
Am J Med. 1985 Sep 13;79(3A):25-9. doi: 10.1016/0002-9343(85)90490-5.
The traditional concept of myocardial ischemia precipitated by increases in the myocardial demand for oxygen is well accepted for patients with fixed coronary atherosclerosis. Recently, however, observations of abnormal vasomotor tone in the coronary artery bed have suggested that vasoconstriction at an atherosclerotic site may be a primary cause of decreases in the myocardial supply of oxygen. This has led to a classification of mixed ischemic subsets characterized by the superimposition of an increased myocardial oxygen demand on a decreased myocardial oxygen supply. The subsets are defined by several clinical parameters, including unstable angina pectoris, acute myocardial infarction, malignant ventricular arrhythmias, mixed angina pectoris, and asymptomatic or silent ischemia. Holter monitoring, electrocardiography, and evaluations of wall motion have confirmed the existence of asymptomatic ischemic episodes that far outnumber episodes of angina in patients with stable angina pectoris. This concept has considerable diagnostic and therapeutic implications.
对于患有固定性冠状动脉粥样硬化的患者而言，因心肌需氧量增加而引发心肌缺血的传统观念已被广泛接受。然而，最近对冠状动脉床血管舒缩张力异常的观察表明，动脉粥样硬化部位的血管收缩可能是心肌氧供应减少的主要原因。这导致了一种混合性缺血亚组的分类，其特征是在心肌氧供应减少的基础上叠加心肌需氧量增加。这些亚组由几个临床参数定义，包括不稳定型心绞痛、急性心肌梗死、恶性室性心律失常、混合型心绞痛以及无症状或静息性缺血。动态心电图监测、心电图检查和室壁运动评估已证实，在稳定型心绞痛患者中，无症状缺血发作的存在远远超过心绞痛发作。这一概念具有相当大的诊断和治疗意义。
