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目的探讨由冠状动脉(简称冠脉)痉挛引起心律失常的处理方法及有效性。方法8例晕厥发作时心电图提示下壁导联ST段抬高伴完全性房室传导阻滞,2例胸闷继发黑矇,无症状发作时心电图正常。明确无水、电解质紊乱后,予以心脏超声、动态心电图、心电监护、冠脉造影检查,明确诊断和病因后予以相应的处理。结果10例生化及心脏超声正常。8例发作性Ⅲ度房室传导阻滞入院的患者,除1例发现右冠脉开口狭窄20%～30%外,其余患者冠脉造影均正常,均置入单腔心室起搏器后使用钙拮抗剂。2例胸闷伴黑矇患者中的1例,造影前Holter发现V1～V6导联ST段抬高伴短阵室性心动过速(简称室速),冠脉造影发现左前降支近段粥样斑块形成,狭窄程度<50%,考虑室速发生的原因是粥样斑块基础上痉挛所致,直接支架植入。另1例造影前无症状发作,造影发现左前降支近段粥样斑块形成,狭窄程度<50%,未予干预,当晚患者症状再发,心电监护发现V1～V6导联ST段抬高伴短阵室速,考虑室速发生的原因与上相同,急诊植入支架。所有患者随访6月至11年,均健在,无类似发作,生活状况良好。结论对于冠脉痉挛引起的心律失常,针对其病变基础采用稳定斑块、起搏支持下的抗痉挛治疗有效。
Objective To investigate the treatment and effectiveness of arrhythmia caused by coronary artery spasm. Methods 8 cases of syncope seizure ECG prompted inferior leads ST segment elevation with complete atrioventricular block, 2 cases of chest tightness secondary to amaurosis, asymptomatic seizures ECG normal. Clear water, electrolyte imbalance, to be echocardiography, Holter, ECG, coronary angiography, a clear diagnosis and cause of the corresponding treatment. Results 10 cases of normal biochemical and cardiac ultrasound. 8 patients with episodic third-degree AV block admitted to hospital, except one case found that the right coronary artery stenosis 20% to 30%, the rest of the patients were normal coronary angiography, were placed in single-chamber ventricular pacemaker after use Calcium antagonists. 2 patients with chest tightness associated with amaurosis in 1 case, Holter found V1 ~ V6 lead ST segment elevation with paroxysmal ventricular tachycardia (referred to as VT), coronary angiography found near the left anterior descending branch of atherosclerotic Plaque formation, the degree of stenosis <50%, considering the occurrence of ventricular tachycardia due to atherosclerosis spasm, direct stent implantation. Another case of asymptomatic angiography before angiography found near the left anterior descending branch of atherosclerotic plaque formation, the degree of stenosis <50%, without intervention, the patient’s recurrence of symptoms that night, ECG found V1 ~ V6 lead ST segment elevation High with mammography, ventricular tachycardia due to the same reasons, the emergency implant stent. All patients were followed up for 6 months to 11 years, were alive, no similar attacks, living in good condition. Conclusions For the arrhythmia caused by coronary spasm, a stable plaque was applied to the basis of the lesion, and the antispasmodic treatment with pacing support was effective.