ROLE OF CORONARY ARTERIAL SPASM IN SUDDEN CORONARY ISCHEMIC DEATH
ROLE OF CORONARY ARTERIAL SPASM IN SUDDEN CORONARY ISCHEMIC DEATH
复制标题
冠状动脉痉挛在冠状动脉缺血性猝死中的作用
DOI：
10.1111/j.1749-6632.1982.tb55218.x
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发表时间：
1982
影响因子：
5.2
通讯作者：
P. Marzullo
中科院分区：
文献类型：
--
作者：
A. Maseri;S. Severi;P. Marzullo
冠状动脉猝死是一种由不同机制引起的综合征，在采取预防措施时应分别考虑所有这些机制。室性颤动、心动过速和完全性房室传导阻滞反复出现在由痉挛引起的缺血性发作中，无论是否存在心绞痛。因此，痉挛是冠状动脉猝死的潜在原因。变异性心绞痛是一种相当可靠的冠状动脉痉挛指标，大约25%的患者会出现心律失常，而且往往在同一患者身上复发。发生严重心律失常的患者的冠状动脉粥样硬化的严重程度变化很大，与没有发生严重心律失常的患者没有什么不同。严重疾病患者的死亡率要高得多，但血管造影显示动脉正常的患者也可能发生纤颤和死亡。在这些患者中，用硝酸盐和慢速通道阻滞剂进行急性和长期治疗似乎取得了显著的效果。对于继发于血管痉挛引起的急性缺血发作的心律失常患者，应通过预防血管痉挛来预防心律失常。
Sudden coronary death is a syndrome caused by different mechanisms, all of which should be separately considered with respect to preventive measures. Ventricular fibrillation, tachycardia, and complete atrioventricular block were repeatedly observed during ischemic episodes caused by spasm in both the presence and absence of anginal pain. Spasm is, therefore, a potential cause of sudden coronary death. In "variant" angina, which is a reasonably reliable indicator of coronary spasm, arrhythmias occur in about 25% of patients and tend to recur in the same patient. The severity of coronary atherosclerosis in patients who develop severe arrhythmias is quite variable and not dissimilar from patient who do not. Mortality is considerably higher in patients with severe disease, but fibrillation and death can occur also in patients with angiographically normal arteries. In these patients acute and long-term treatment with nitrates and slow channel blockers appears to give remarkable results. Prevention of arrhythmias in patients in whom arrhythmias are secondary to acute ischemic episodes caused by vasospasm should be attempted by preventing vasospasm.