A Study on Pathogenesis and Treatment of Angina Pectoris

本文对126例单支病变心绞痛患者反复进行平板运动试验，观察不同药物对运动诱发发作的影响。64例（50.8%）患者在一周内的不同日期的同一时间进行最大跑步机运动不能诱发或不能重复诱发发作。在62例运动可重复诱发发作的患者中，口服普萘洛尔80 mg对52例（83.9%）患者的发作无抑制作用。口服地尔硫卓90 mg和硝苯地平20 mg分别使62例患者中的48例（77.4%）和57例患者中的42例（73.7%）完全抑制发作。62例患者中除1例在发作时行冠状动脉造影外，其余患者发作时均出现ST段偏移所代表的心肌供血动脉的动态阻塞，并随发作的消退而消失。我们的结论是，心绞痛通常不是由心肌需氧量增加，而是由动态冠状动脉阻塞或两者的组合，在大多数患者的血管疾病和钙拮抗剂，如地尔硫卓和硝苯地平是非常有用的治疗心绞痛患者的一个血管疾病。

We performed treadmill exercise test repeatedly and examined the effects of various drugs on the exercise-induced attack in 126 patients with angina pectoris with one vessel disease. The attacks could not be induced or could not be reproducibly induced by maximal treadmill exercise at the same hour of the different days within a week period in 64 (50.8 %) of the patients. In the 62 patients whose attacks were reproducibly induced by the exercise, propranolol 80 mg given orally did not suppress the attacks in 52 (83.9 %) of the patients. Diltiazem 90 mg and nifedipine 20 mg given orally suppressed the attacks completely in 48 (77.4 %) of the 62 patients and in 42 (73.7 %) of the 57 patients respectively. Coronary arteriography showed that dynamic obstruction of the artery supplying the area of myocardium represented by ST segment deviation appeared during the attacks and disappeared with subsidence of the attacks in all but 1 of the 62 patients in whom coronary arteriography was done during the attack. We conclude that angina pectoris is usually cause not by increased myocardial oxygen demand but by dynamic coronary obstruction or by combination of both in most patients with on vessel disease and that calcium antagonists such as diltiazem and nifedipine are very useful for the treatment of angina pectoris in patients with one vessel disease.