Deanfield J E, Shea M, Kensett M, Horlock P, Wilson R A, de Landsheere C M, Selwyn A P
Lancet. 1984 Nov 3;2(8410):1001-5. doi: 10.1016/s0140-6736(84)91106-1.
Patients with angina and coronary disease have many episodes of symptomless transient myocardial ischaemia, most of which cannot be explained by physical exertion. 16 patients with typical stable angina pectoris were examined to test the hypothesis that these episodes can be triggered off by ordinary daily events, such as changes in mental activity. Regional myocardial perfusion and ischaemia were assessed by measurement of the uptake of rubidium-82 with positron tomography after mental arithmetic and physical exercise. With mental arithmetic, 12 (75%) patients had abnormalities of regional perfusion, accompanied in only 6 by ST-segment depression and in 4 of these 6 by angina, leaving 6 patients with perfusion abnormalities but neither pain nor electrocardiographic changes. After exercise, all the patients showed abnormal regional myocardial perfusion in the segments that became ischaemic with mental arithmetic. This was accompanied by ST depression in all and angina in 15. The association between mental activity and myocardial ischaemia may operate frequently during everyday life and may explain many of the transient and symptomless electrocardiographic changes in patients with coronary disease.
患有心绞痛和冠心病的患者会出现许多无症状性短暂心肌缺血发作，其中大多数无法用体力活动来解释。对16例典型稳定型心绞痛患者进行了检查，以验证这些发作可由日常普通事件（如精神活动变化）触发的假说。通过在进行心算和体育锻炼后用正电子断层扫描测量铷-82摄取量，评估局部心肌灌注和缺血情况。在心算时，12例（75%）患者出现局部灌注异常，其中仅有6例伴有ST段压低，这6例中有4例伴有心绞痛，其余6例有灌注异常但既无疼痛也无心电图改变。运动后，所有患者在心算时出现缺血的节段均显示局部心肌灌注异常。所有患者均伴有ST段压低，15例伴有心绞痛。精神活动与心肌缺血之间的关联可能在日常生活中频繁发生，并且可能解释冠心病患者许多短暂且无症状的心电图变化。
