Hagman M, Wilhelmsen L
Acta Med Scand Suppl. 1981;644:16-8. doi: 10.1111/j.0954-6820.1981.tb03109.x.
Dyspnea may form a differential diagnostic symptom to chest pain in ischemic heart disease (IHD) but may also precede angina pectoris (AP) as a manifestation of IHD. In the Primary Preventive Trial in Göteborg the occurrence of AP and its relation to dyspnea has been studied in a random population sample of men aged 47-54 years at entry to the study and followed for 4 years. In the corss-sectional study dyspnea was reported in 21% of the total population and in 70% of the angina population. Dyspnea at entry to the study was reported in 36% among cases who developed AP along during the follow-up time and in 35% among cases who developed AP associated with myocardial infarction. The dyspnea was not related to smoking habits or to low grade of physical activity. The report of dyspnea before chest pain in IHD may be due to misinterpretation in early cases. On the other hand it is also known that intermittent left ventricular failure coincident with attacks of myocardial ischemia will give a subjective feeling of dyspnea. According to our study there is a definite association between AP and dyspnea. In some cases dyspnea precedes AP whereas in others the chest pain precedes the dyspnea. The symptom dyspnea also carries important prognostic information in IHD.
呼吸困难可能是缺血性心脏病（IHD）中胸痛的鉴别诊断症状，但也可能作为IHD的一种表现先于心绞痛（AP）出现。在哥德堡初级预防试验中，对年龄在47 - 54岁、进入研究时为男性的随机人群样本进行了研究，随访4年，观察了AP的发生情况及其与呼吸困难的关系。在横断面研究中，21%的总人口报告有呼吸困难，心绞痛人群中这一比例为70%。在随访期间单纯发生AP的病例中，36%在进入研究时报告有呼吸困难；发生与心肌梗死相关的AP的病例中，35%在进入研究时报告有呼吸困难。呼吸困难与吸烟习惯或低水平体力活动无关。IHD中胸痛前出现呼吸困难的报告可能是由于早期病例的误诊。另一方面，也已知心肌缺血发作时伴有间歇性左心室衰竭会产生主观的呼吸困难感。根据我们的研究，AP与呼吸困难之间存在明确的关联。在某些情况下，呼吸困难先于AP出现，而在另一些情况下，胸痛先于呼吸困难出现。呼吸困难症状在IHD中也具有重要的预后信息。
