Maseri A, Chierchia S, Davies G, Glazier J
Am J Med. 1985 Sep 13;79(3A):7-11. doi: 10.1016/0002-9343(85)90487-5.
The mechanisms of cardiac ischemic pain remain obscure. It is unknown whether ischemia causes cardiac pain by the release of chemical substances or by mechanical stretching. It is also unknown whether ischemia activates specific nociceptors and pain fibers or mechanoreceptors and chemoreceptors. In patients who have both painful and painless ischemic episodes, a certain minimal duration and severity of ischemia are necessary but insufficient to explain the presence of pain, since very severe ischemia of long duration can be silent. Thus, central transmission of painful stimuli and the pain perception threshold appear to play major roles in determining the presence or absence of pain. The emotional state and psychologic expectations of patients may affect their perception and threshold of pain considerably.
心脏缺血性疼痛的机制仍不清楚。目前尚不清楚缺血是通过化学物质的释放还是机械性拉伸导致心脏疼痛。也不清楚缺血是激活了特定的伤害感受器和痛觉纤维，还是机械感受器和化学感受器。在既有疼痛性缺血发作又有无痛性缺血发作的患者中，一定的最小缺血持续时间和严重程度是必要的，但不足以解释疼痛的存在，因为长时间的非常严重的缺血可能是无症状的。因此，疼痛刺激的中枢传导和痛觉阈值似乎在决定疼痛的有无方面起主要作用。患者的情绪状态和心理预期可能会相当大地影响他们对疼痛的感知和阈值。
