心絞痛的鑒別心絞痛(編輯修改稿)
2025-06-20 04:41 本頁面
【文章內(nèi)容簡介】 near syncope。 – Sign of poor perfusion。 – Technical difficulties。 – Sustained VT。 – ST elevation in leads without Q waves. Noninvasive Testing: Exercise ECG(5) (Relative indication for stopping): ? SBP drop 10mmHg without ischemia。 ? SBP 250 or DBP 115mmHg。 ? ST depression 2mm。 ? Marked axis deviation。 ? Multifocal PVCs, triplets PVCs, SVT, heart block or bradyarrhythmias, BBB or IVCB ? Increasing chest pain。 Serious symptoms. Noninvasive Testing: Exercise ECG(6) ? Sensitivity: 68%。 Specificity: 77% ? Influence of other factors on test: – Digoxin: 2540% abnormal ST depression. – Beta blockers: Gradually withheld 48hrs. – AntiHBP, vasodilators, nitrates, flacainide. – LBBB: – RBBB: – LV hypertrophy: More falsepositive. – Rest ST depression: Additional ST? significant. Stress Imaging Studies ? Good candidates for stress imaging, as opposed to exercise ECG: – CLBBB, Paced rhythm, WPW etc. – ST ? 1mm at rest, – Unable to exercise, – Angina with prior Revascularization. Pharmacologic Modalities (Vasodilators) Used in Stress Imaging ? Dipyridamole(DIP) inhibiting cellular uptake of adenosine (a potent coronary vasodilators). ? The flow increase by adenosine is of lesser magnitude through stenostic arteries, creating heterogeneous myocardial perfusion. ? Side effects of both DIP and ADE are rare, but may cause severe bronchospasm in patients with asthma or COPD. Pharmacologic Modalities (Dobutamine) Used in Stress Imaging ? In high doses (20 to 40?g /kg /min) increases HR, SBP and myocardial contractility. ? The flow increase(23 times) is less than that elicited by adenosine or dipyridamole. ? Side effects are frequent, but the test appears to be safe even in the elderly, including nausea, anxiety, headache, tremor, VPC, APC, SVT, nonsustVT, chest pain and a
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