"正常"冠状动脉的胸痛:不断变化的哲学
Raffaele Bugiardini1, C Noel Bairey Merz
1Department of Internal Medicine, Cardio-Angiology and Hepatology, University of Bologna, Bologna, Italy. raffaele.bugiardini@unibo.it
JAMA
|January 27, 2005
概括
患有胸痛和冠状动脉正常的女性往往有严重的病情. 他们的预后不是良性的,进一步评估心脏事件风险和向治疗是至关重要的.
科学领域:
- 心脏病学 心脏病学
- 血管医学 血管医学
背景情况:
- 许多患有胸痛的女性接受诊断,尽管冠状动脉正常,但没有显著的心脏病.
- 放心通常是唯一提供的治疗方法,可能会推迟必要的干预措施.
研究的目的:
- 审查患有正常或非阻塞性冠状动脉的患者心痛的诊断和治疗.
- 突出这一患者群体的预后和治疗策略被低估.
主要方法:
- 在2004年6月之前对MEDLINE和Cochrane系统评论数据库进行系统的文献搜索.
- 包括参考清单和会议演示文稿,以获得全面的数据.
- 关键词集中在心痛的诊断和治疗与正常血管造影.
主要成果:
- 正常或非阻塞性冠状动脉疾病很常见,特别是在患有心肌梗塞的女性中.
- 患有非阻塞性疾病的患者更有可能是女性和非白人,症状与阻塞性疾病无法区分.
- 在正常血管造影的女性中,很大一部分由于内皮功能障碍而表现出心肌缺血,这表明未来心脏事件风险增加.
结论:
- 有正常血管图的胸痛主要影响女性,并且预后比通常认为的更严重.
- 内皮功能评估可以识别患有未来心脏事件风险的患者.
- 治疗应包括缓解症状 (三环药物,β-阻塞剂) 和基于危险因素的积极抗动脉样硬化治疗 (他类药物,ACE抑制剂).
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