Gardin J M, Isner J M, Ronan J A, Fox S M
Am J Cardiol. 1980 May;45(5):952-8. doi: 10.1016/0002-9149(80)90162-9.
Hyperventilation-induced S-T segment changes that simulate myocardial ischemia have previously been noted, but the origin of this electrocardiographic finding has never been defined. To investigate further the basis for this response, the records were reviewed of 1,678 consecutive patients who underwent forced hyperventilation for 90 seconds and treadmill exercise testing. Twenty-eight patients (1.7 percent) were identified in whom hyperventilation resulted in ischemic-appearing S-T segment changes, and follow-up was possible in 21 (17 women, 4 men). Of the 21 patients, 16 (76 percent), including 15 (88 percent) of the 17 women, had evidence of mitral valve prolapse, 6 on auscultation alone, 2 on echocardiography alone and 6 with a combination of studies. Ten of the 21 patients had a negative exercise test; of the 11 patients who had a positive exercise test, only 1 had angiographic evidence of coronary arterial narrowing. The finding of ischemic-appearing S-T segment changes in response to forced hyperventilation has a high predictive value for the presence of mitral valve prolapse, particularly in women. The possible association of autonomic factors and mitral valve prolapse in the pathogenesis of an abnormal response to hyperventilation is discussed.
此前已注意到过度换气诱发的类似心肌缺血的ST段改变，但这种心电图表现的起源从未明确。为进一步研究这种反应的基础，回顾了1678例连续接受90秒强迫过度换气及平板运动试验患者的记录。28例患者（1.7%）被确定为过度换气导致出现缺血样ST段改变，其中21例（17例女性，4例男性）可进行随访。在这21例患者中，16例（76%）包括（17例女性中的）15例（88%）有二尖瓣脱垂证据，其中6例仅通过听诊发现，2例仅通过超声心动图发现，6例通过多种检查联合发现。21例患者中有10例运动试验结果为阴性；在11例运动试验结果为阳性的患者中，只有1例有冠状动脉狭窄的血管造影证据。强迫过度换气时出现缺血样ST段改变这一发现对二尖瓣脱垂的存在具有较高的预测价值，尤其是在女性中。本文讨论了自主神经因素与二尖瓣脱垂在过度换气异常反应发病机制中可能的关联。
