Oliva P B
Ann Intern Med. 1984 Mar;100(3):424-40. doi: 10.7326/0003-4819-100-3-424.
Because of recent findings, a reassessment is needed of the concept that rest angina associated with ST-segment depression is due to a spontaneous, transient increase of blood pressure or heart rate, or both, in the presence of critical coronary artery stenosis. Continuous hemodynamic and electrocardiographic recordings done before and during attacks of rest angina and thallium-201 scintigrams done during pain indicate that a transient reduction of flow is the immediate cause of ischemia in most, but not all, instances. Flow reduction, in turn, appears to be due to coronary arterial spasm or platelet aggregation, or both, acting at a site of atherosclerotic narrowing. Therapy for unstable rest angina should include measures to prevent both transient reductions of flow and increases of myocardial oxygen consumption. A combination of long-acting nitrates, a beta-blocker, a calcium-channel blocker, and aspirin or heparin is suggested for this purpose. Intravenous nitroglycerin is useful when angina occurs despite this therapy or when frequent attacks of ischemia are occurring at the time of admission.
鉴于最近的研究结果，有必要重新评估以下观念：伴有ST段压低的静息性心绞痛是由于在严重冠状动脉狭窄情况下血压或心率自发、短暂升高，或两者同时升高所致。在静息性心绞痛发作前和发作期间进行的连续血流动力学和心电图记录，以及疼痛发作期间进行的铊-201闪烁扫描表明，在大多数（但不是所有）情况下，血流的短暂减少是缺血的直接原因。血流减少反过来似乎是由于冠状动脉痉挛或血小板聚集，或两者共同作用于动脉粥样硬化狭窄部位所致。不稳定型静息性心绞痛的治疗应包括预防血流短暂减少和心肌氧耗增加的措施。为此建议联合使用长效硝酸盐、β受体阻滞剂、钙通道阻滞剂以及阿司匹林或肝素。尽管采用了这种治疗方法，但仍发生心绞痛或入院时频繁发生缺血发作时，静脉滴注硝酸甘油是有用的。
