A Study on Pathogenesis and Treatment of Angina Pectoris

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。在患者中，50.8%的患者不能或不能在一周内不同天的同一时间的同一时间进行最大跑台运动诱发发作。在62例运动诱发的重复性发作患者中，52例(83.9%)口服心得安80 mg不能抑制发作。口服地尔硫卓90 mg和硝苯地平20 mg分别完全抑制发作48例(77.4%)和42例(73.7%)。冠脉造影术显示，发作期除1例患者外，其余62例患者均出现供血ST段偏移的心肌区动脉的动态阻塞，随发作消退而消失。我们的结论是，在大多数冠状动脉病变患者中，心绞痛通常不是由心肌耗氧量增加引起的，而是由动态冠脉阻塞或两者联合引起的。钙拮抗剂如地尔硫卓和硝苯地平对单支病变患者的心绞痛非常有效。

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.