壁冠状动脉性心脏病四例诊治体会(摘要)
作者：张兴华 朱兴雷 陈良华 时强 唐元升 许法运 王金锋 王克平 邵建华
单位：山东省济南市，山东省立医院 心内科(250021)
关键词：
中国循环杂志99zk88 目的：壁冠状动脉是一种冠状动脉的先天性走行变异，大多数壁冠状动脉患者并无症状，有症状者常在中年以后，其症状酷似冠心病。因此，壁冠状动脉所致的心脏病又称为壁冠状动脉性心脏病。本文初步探讨壁冠状动脉性心脏的诊断和治疗。
方法和结果：例1，男性，32岁，因饮酒后胸骨后疼痛、低血压半小时入院，心电图显示室性心动过速，利多卡因75 mg静脉注射后恢复窦性心律，血压恢复正常。肌酸激酶及肌酸激酶及其同工酶MB均升高，心电图显示急性非Q波性心肌梗塞，其父亲40岁死于心脏性猝死，半月后冠状动脉造影显示左冠状动脉前降支中段有8～10 mm的壁冠状动脉，收缩期狭窄≥75%,用消心痛、心得安治疗效果良好出院。例2，男性，36岁，因劳力性头晕、胸痛两次入院，心电图正常，动态发现患者在上楼时有T波倒置及ST段稍下移等非特异性改变，心脏超声检查正常，冠状动脉造影显示左冠状动脉前降支中段有5～8 mm的壁冠状动脉，收缩期狭窄50%～75%。服用倍他乐克25 mg/次，每日2次治疗，未再发生上述症状。例3，男性，45岁，过度劳累及情绪激动时发生胸骨后闷痛、大汗流浃背1个月入院，症状发作时心电图Ⅱ、Ⅲ、aVF ST抬高，休息或含化硝酸甘油有效。冠状动脉造影显示右冠状动脉远段有约15 mm的壁冠状动脉，收缩期狭窄≥75%,用消心痛、硫氮唑酮治疗有效。例4，女性，38岁，过度脑力劳动及精神紧张时心前区闷痛2个月入院，症作发作时心电图V1～5波倒置。含化硝酸甘油有效。冠状动脉造影显示左冠状动脉前降支中段有10～15 mm的壁冠状动脉，收缩期狭窄≥50%，用消心痛、心得安治疗效果良好出院。
, http://www.100md.com
结论：壁冠状动脉性心脏病的主要症状为劳力型心绞痛、心动过速，重者可发生急性心肌梗塞或心脏性猝死；心电图无特异性改变；冠状动脉造影发现冠状动脉收缩期狭窄为主要诊断依据；有症状者，静息状态下其收缩期狭窄≥50%～75%;血管内超声检查也可明确诊断；主要治疗措施为药物治疗、介入治疗及手术治疗。
Diagnosis and Treatment of Mural Coronary Disease: A Four Case Report (Abstract)
Department of Cardiology, Shandong Provincial Hospital, Ji′nan (250021), Shandong
Zhang Xinghua, Zhu Xinglei, Chen Lianghua, et al.
Objective: To report 3 cases of mural coronary artery disease.
, 百拇医药
Methods: Using modern cardiologic techniques to charactrize mural coronary artery disease.
Results: Patients with mural coronary artery showed typical ischemic ST-T change, ventricular arrhythmia or infarction-like change on electrocardiogram. Tachycardia, coronary spasm, atherosclerosis of distal to mural coronary artery and thrombosis were in volved in pathogenesis of myocardial infarction. Angiography showed a systolic narrowing of coronary artery. Mest patients are asymptomatic at earlier stage, the symptoms, however, can occur in some patients after middle age. For treatment, β-receptor blodlers and nitrates were effective, however, coronary stent, supraarterial of myocardial bridye, or coronary artery by pass graft may also be considered.
Conclusion: Mural coronary artery can be diagnosed by coronary angiography. The symptoms can be released by medications. Interventional cardiologic techniques or bypass operation may also be considered., http://www.100md.com
单位：山东省济南市，山东省立医院 心内科(250021)
关键词：
中国循环杂志99zk88 目的：壁冠状动脉是一种冠状动脉的先天性走行变异，大多数壁冠状动脉患者并无症状，有症状者常在中年以后，其症状酷似冠心病。因此，壁冠状动脉所致的心脏病又称为壁冠状动脉性心脏病。本文初步探讨壁冠状动脉性心脏的诊断和治疗。
方法和结果：例1，男性，32岁，因饮酒后胸骨后疼痛、低血压半小时入院，心电图显示室性心动过速，利多卡因75 mg静脉注射后恢复窦性心律，血压恢复正常。肌酸激酶及肌酸激酶及其同工酶MB均升高，心电图显示急性非Q波性心肌梗塞，其父亲40岁死于心脏性猝死，半月后冠状动脉造影显示左冠状动脉前降支中段有8～10 mm的壁冠状动脉，收缩期狭窄≥75%,用消心痛、心得安治疗效果良好出院。例2，男性，36岁，因劳力性头晕、胸痛两次入院，心电图正常，动态发现患者在上楼时有T波倒置及ST段稍下移等非特异性改变，心脏超声检查正常，冠状动脉造影显示左冠状动脉前降支中段有5～8 mm的壁冠状动脉，收缩期狭窄50%～75%。服用倍他乐克25 mg/次，每日2次治疗，未再发生上述症状。例3，男性，45岁，过度劳累及情绪激动时发生胸骨后闷痛、大汗流浃背1个月入院，症状发作时心电图Ⅱ、Ⅲ、aVF ST抬高，休息或含化硝酸甘油有效。冠状动脉造影显示右冠状动脉远段有约15 mm的壁冠状动脉，收缩期狭窄≥75%,用消心痛、硫氮唑酮治疗有效。例4，女性，38岁，过度脑力劳动及精神紧张时心前区闷痛2个月入院，症作发作时心电图V1～5波倒置。含化硝酸甘油有效。冠状动脉造影显示左冠状动脉前降支中段有10～15 mm的壁冠状动脉，收缩期狭窄≥50%，用消心痛、心得安治疗效果良好出院。
, http://www.100md.com
结论：壁冠状动脉性心脏病的主要症状为劳力型心绞痛、心动过速，重者可发生急性心肌梗塞或心脏性猝死；心电图无特异性改变；冠状动脉造影发现冠状动脉收缩期狭窄为主要诊断依据；有症状者，静息状态下其收缩期狭窄≥50%～75%;血管内超声检查也可明确诊断；主要治疗措施为药物治疗、介入治疗及手术治疗。
Diagnosis and Treatment of Mural Coronary Disease: A Four Case Report (Abstract)
Department of Cardiology, Shandong Provincial Hospital, Ji′nan (250021), Shandong
Zhang Xinghua, Zhu Xinglei, Chen Lianghua, et al.
Objective: To report 3 cases of mural coronary artery disease.
, 百拇医药
Methods: Using modern cardiologic techniques to charactrize mural coronary artery disease.
Results: Patients with mural coronary artery showed typical ischemic ST-T change, ventricular arrhythmia or infarction-like change on electrocardiogram. Tachycardia, coronary spasm, atherosclerosis of distal to mural coronary artery and thrombosis were in volved in pathogenesis of myocardial infarction. Angiography showed a systolic narrowing of coronary artery. Mest patients are asymptomatic at earlier stage, the symptoms, however, can occur in some patients after middle age. For treatment, β-receptor blodlers and nitrates were effective, however, coronary stent, supraarterial of myocardial bridye, or coronary artery by pass graft may also be considered.
Conclusion: Mural coronary artery can be diagnosed by coronary angiography. The symptoms can be released by medications. Interventional cardiologic techniques or bypass operation may also be considered., http://www.100md.com