动态心电图监测变异型心绞痛1例.docVIP

动态心电图监测变异型心绞痛1例[摘要] 患者男，48岁，因心前区疼痛伴紧缩感3d每于凌晨发作，持续3～4min后自行缓解，常规心电图检查无异常，既往高血压病史8年，于2011年5月10日就诊。24h 12导联同步动态心电图记录到ST段呈损伤样改变伴Ⅱ度Ⅱ型房室传导阻滞。临床诊断：冠心病、变异型心绞痛，Ⅱ度Ⅱ型房室传导阻滞、高血压病。变异型心绞痛发作时间短，常规心电图难以诊断，24h 12导联同步动态心电图可获得10万个心动周期心电信息，清楚地显示出变异型心绞痛发作的时间分布、持续时间、心肌缺血的部位与程度，为临床诊断提供可靠依据。 [关键词] 动态心电图；变异型心绞痛 [中图分类号] R443+.8 [文献标识码] C [文章编号] 1673-9701（2011）32-141-02 A Case Report：Dynamic Electrocardiogram Monitoring Variant Angina Pectoris QI Bing MAO Rui BAO Yan GAO Jilong Siping Center Hospital，Siping 136000，China [Abstract] A 48-year-old man，presented with onset of chest pain and tightness in the early dawn of last 3 days and alleviated after 3-4 mins spontaneously，conventional electrocardiogram failed to offer any clue. He gave a history of 8 years of hypertension and was admitted on May.10th，2011. A 24 hour 12 lead synchronized dynamic electrocardiogram recorded injury-like S-T segment change and type 2 second-degree atrioventricular block. The patient was diagnosed with coronary heart disease，variant angina pectoris，type 2 second-degree atrioventricular block and hypertension. Variant angina pectoris is hard to be diagnosed by conventional electrocardiogram for its short episode of onset. The 24 hour 12 lead synchronized dynamic electrocardiogram can acquire the information of about 100 thousand cardiac cycles，clearly show the time distribution，duration time，location and degree of myocardial infarction，and offer reliable evidence for diagnose. [Key words] Dynamic electrocardiogram；Variant angina pectoris 变异型心绞痛是自发性心绞痛的一种类型，发作与心肌耗氧量无明显关系；主要由于冠状动脉痉挛引起变异型心绞痛，易发展为急性心肌梗死，同时伴有室速或室颤等恶性心律失常。变异型心绞痛常发生在夜间或清晨，具有周期性，可持续10s～30min，常规心电图很难捕捉到心电图动态演变过程，动态心电图可记录到24h 12导联同步心电图的变化，对变异型心绞痛的及时诊断和治疗有非常重要的临床意义[1]。 1 病例资料 患者男，48岁，心前区不适3d，每天凌晨4点钟自觉心前区疼痛，伴紧缩感，持续3～4min后自行缓解，于2011年5月10日就诊。入院查体：BP：150/80mmHg，双肺呼吸音清，心率80次/min，既往有高血压病史8年，血压最高达185/105mmHg。常规心电图示：窦性心律、正常心电图；运动试验：阴性；心脏彩超：各腔内径正常；24h 12导联同步动态心电图示（图1）：动态心电图记录到ST段Ⅱ、Ⅲ、AVF、V5、V6导联损伤型抬高，对应导联Ⅰ、AVL、AVR、V2、V3导联压低，同时伴有Ⅱ度Ⅱ型房室传导阻滞，持