背景:在本文中,我们将重点关注典型的Prinzmetal心绞痛的ECG变化,这种变化通常发生在正常或非严重冠状动脉狭窄患者的闭塞性近端冠状动脉痉挛期间。
结果:局灶性近端冠状动脉痉挛期间最重要的ECG变化是在大约50%的病例中出现峰值和对称的T波,如果痉挛持续,通过持续几分钟的渐进性ST段抬高,后来逐步解决。与ST段抬高相关的最常见的ECG变化是:(a)R波高度增加,(b)同时减少S波,(c)在许多情况下,TQ向上倾斜,(d)在20%的病例中,ST段抬高和负T波深度的交替。在Prinzmetal心绞痛危机期间,心律失常的存在非常频繁,尤其是室性心律失常.室性心律失常的患病率和重要性与:(a)发作持续时间,(b)ST段抬高程度,(c)存在ST-T波交替,和(d)存在>25%的R波增加。
结论:Prinzmetal心绞痛的发病率比50年前低得多,原因很多,包括钙通道阻断治疗高血压和缺血性心脏病以及减少吸烟习惯。
BACKGROUND: We will focus our attention in this article in the ECG changes of classical Prinzmetal angina that occur during occlusive proximal coronary spasm usually in patients with normal or noncritical coronary stenosis.
RESULTS: The most important ECG change during a focal proximal coronary spasm is in around 50% of cases the appearance of peaked and symmetrical T wave that is followed, if the spasm persist, by progressive ST-segment elevation that last for a few minutes, and later progressively resolve. The most frequent ECG changes associated with ST-segment elevation are: (a) increased height of the R wave, (b) coincident S-wave diminution, (c) upsloping TQ in many cases, and (d) alternans of the elevated ST-segment and negative T wave deepness in 20% of cases. The presence of arrhythmias is very frequent during Prinzmetal angina crises, especially ventricular arrhythmias. The prevalence and importance of ventricular arrhythmias were related to: (a) duration of episodes, (b) degree of ST-segment elevation, (c) presence of ST-T wave alternans, and (d) the presence of >25% increase of the R wave.
CONCLUSIONS: The incidence of Prinzmetal angina is much lower then 50 years ago for many reasons including treatment with calcium channel blocks to treat hypertension and ischemia heart disease and the decrease of smoking habits.