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目的探讨病态窦房结综合征患者非典型性胸痛的病因及临床意义。方法 对34例临床诊断为病态窦房结综合征且需安装心脏永久起搏器、同时伴有非典型性胸痛的患者,在行心脏永久起搏器植入术的同时或术前和术后行冠状动脉造影术,分析冠状动脉病变及左心室功能,其中21例在冠状动脉造影时行乙酰胆碱试验。结果31例患者冠状动脉均正常或狭窄程度<50％,3例患者冠状动脉狡窄程度>75％,但在心动过缓患者可见冠状动脉血流速度明显缓慢。部分患者左心室明显扩大、左心室射血分数足室壁运动降低,9例乙酰胆碱试验阳性。无严重冠状动脉病变者多在起搏器植入术后或合并钙拮抗剂治疗后胸痛消失。结论 病态窦房结综合征患者的非典型性胸痛多数不具有严重冠状动脉病变基础,可能与心动过缓所导致的冠状动脉血流缓慢或冠状动脉痉挛有关,在安装起搏器和服用钙拮抗剂后胸痛多缓解。
Objective To investigate the etiology and clinical significance of atypical chest pain in patients with sick sinus syndrome. Methods Totally 34 patients with sick sinus syndrome who were diagnosed as sick sinus syndrome and were required to have a permanent cardiac pacemaker and atypical chest pain were treated with or without preoperative and postoperative Line coronary angiography, coronary artery lesions and left ventricular function analysis, of which 21 cases of coronary angiography acetylcholine test. Results All 31 patients had normal or stenosed coronary arteries less than 50% and 3 patients had stenosis of more than 75%. However, in patients with bradycardia, coronary blood flow velocity was significantly lower. Some patients significantly enlarged left ventricle, left ventricular ejection fraction decreased ventricular wall motion, 9 cases of acetylcholine test was positive. No serious coronary lesions were more in the pacemaker implantation or after treatment with calcium antagonist disappeared chest pain. Conclusion Sick sinus syndrome in patients with atypical chest pain most do not have the basis of severe coronary artery disease may be caused by slow bradycardia or coronary artery blood flow slow coronary artery spasm related to the installation of pacemakers and take calcium antagonism Pain relief after the agent.