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心绞痛的症状_心绞痛的早期症状有哪些_快速问医生

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根据世界卫生组织“缺血性心脏病的命名及诊断标准”,将心绞痛分为劳累性和自发性两大类。结合近年对心绞痛病人深入观察提出的一些类型,现将心绞痛归纳如下的三大类:</p><p>  (一)劳累性心绞痛(anginapectorisofeffort)是由运动或其他增加心肌需氧量的情况所诱发的心绞痛。包括3种类型:</p><p>  1、稳定型劳累性心绞痛简称稳定型心绞痛(stableaninapectoris),亦称普通型心绞痛,是最常见的心绞痛。指由<a target='_blank' href="http://tag.120ask.com/jibing/xjqx/" style='color:#145b7d;text-decoration:underline;' >心肌缺血</a>缺氧引起的典型心绞痛发作,其性质在1~3个月内并无改变。即每日和每周疼痛发作次数大致相同,诱发疼痛的劳累和情绪激动程度相同,每次发作疼痛的性质和疼痛部位无改变,疼痛时限相仿(3~5分钟),无长达10~20分钟或以上者,用硝酸甘油后也在相同时间内发生疗效。</p><p>  本型心绞痛发作时,病人表情<a target='_blank' href="http://tag.120ask.com/zhengzhuang/jiaolv/" style='color:#145b7d;text-decoration:underline;' >焦虑</a>,皮肤苍白、冷或出汗。血压可略增高或降低,心尖区可有<a target='_blank' href="http://tag.120ask.com/zhengzhuang/ssqzy/" style='color:#145b7d;text-decoration:underline;' >收缩期杂音</a>(二尖瓣乳头肌功能失调所致)。第二心音可有逆分裂,还可有<a target='_blank' href="http://tag.120ask.com/zhengzhuang/jtm/" style='color:#145b7d;text-decoration:underline;' >交替脉</a>或心前区抬举性搏动等体征。</p><p>  二度Ⅰ型<a target='_blank' href="http://tag.120ask.com/jibing/fscdzz/" style='color:#145b7d;text-decoration:underline;' >房室传导阻滞</a>图册</p><p>  病人休息时心电图50%以上属正常,异常心电图包括ST段和T波改变、房室传导阻滞、束支传导阻滞、左束支前分支或后分支阻滞、左<a target='_blank' href="http://tag.120ask.com/zhengzhuang/xsfd/" style='color:#145b7d;text-decoration:underline;' >心室肥大</a>或<a target='_blank' href="http://tag.120ask.com/zhengzhuang/xlsc/" style='color:#145b7d;text-decoration:underline;' >心律失常</a>等,偶有阵旧性心肌梗塞表现。疼痛发作时心电图可呈典型的缺血性ST段压低的改变。</p><p>  2、初发型劳累性心绞痛简称初发型心绞痛(initial onset angin</p><p>  <a target='_blank' href="http://tag.120ask.com/jibing/sxqqss/" style='color:#145b7d;text-decoration:underline;' >室性期前收缩</a>图册a pectoris)。指病人过去未发生过心绞痛或心肌梗塞,而现在发生由心肌缺血缺氧引起的心绞痛,时间尚在1~2个月内。有过稳定型心绞痛但已数月不发生心绞痛的病人再发生心绞痛时,有人也归入本型。</p><p>  本型心绞痛的性质、可能出现的体征、心电图和X线发现等,与稳定型心绞痛相同,但心绞痛发作尚在1~2个月内。以后多数病人显示为稳定型心绞痛,但也可能发展为恶化型心绞痛,甚至心肌梗塞。</p><p>  3、恶化型劳累性心绞痛简称恶化型心绞痛,亦称进行型心绞痛(progressive angina pectoris)。指原有稳定型心绞痛的病人,在3个月内疼痛的频率、程度、诱发因素经常变动,进行性恶化,病人的痛阈逐步下降,于是较轻的体力活动或情绪激动即能引起发作,故发作次数增加,疼痛程度较剧,发作的时限延长,可超过10分钟,用硝酸甘油后不能使疼痛立即或完全消除。发作时心电图示ST段明显压低与T波倒置,但发作后又恢复,且不出现心肌梗塞的变化。</p><p>  恶化型心绞痛图册本型心绞痛反映冠状动脉病变有所发展,预后较差。可发展为急性透壁性心肌梗塞,部分病人实际上可能已发生较小的心肌梗塞(未透壁)或散在性心内膜下心肌梗塞灶,只是在心电图中未能得到反映而已。也可发生<a target='_blank' href="http://tag.120ask.com/zhengzhuang/cusi/" style='color:#145b7d;text-decoration:underline;' >猝死</a>。但也有一部分患稳定型心绞痛多年的病人,可在一个阶段中呈现心绞痛的进行性增剧,然后又逐渐恢复稳定。</p><p>  (二)自发性心绞痛(angina pectoris at rest)心绞痛发作与心肌需氧量无明显关系,与劳累性心绞痛相比,疼痛持续时间一般较长,程度较重,且不易为硝酸甘油所缓解。包括四种类型:</p><p>  1、卧位型心绞痛(anginadecubitus)亦称休息时心绞痛。指在休息时或熟睡时发生的心绞痛,其发作时间较长,症状也较重,发作与体力活动或情绪激动无明显关系,常发生在半夜,偶尔在午睡或休息时发作。疼痛常剧烈难忍,病人烦躁不安,起床走动。体征和心电图变化均较稳定型心绞痛明显,硝酸甘油的疗效不明显,或仅能暂时缓解。</p><p>  本型心绞痛可由稳定型心绞痛、初发型心绞痛或恶化型心绞痛发展而来,病情加重,预后甚差,可发展为急性心肌梗塞或发生严重心律失常而死亡。其发生机理尚有争论,可能与夜梦、夜间血压降低或发生未被察觉的左心室衰竭,以致狭窄的冠状动脉远端心肌灌注不足;或平卧时静脉回流增加,心脏工作量增加,需氧增加等有关。</p><p>  2、<a target='_blank' href="http://tag.120ask.com/jibing/byxxjt/" style='color:#145b7d;text-decoration:underline;' >变异型心绞痛</a>(Prinzmetal's variant angina pectoris)本型病人心绞痛的性质与卧位型心绞痛相似,也常在夜间发作,但发作时心电图表现不同,显示有关导联的ST段抬高,而之相对应的导联中则 ST段压低(其它类型心绞痛则除aVR及V1外各导联ST段普遍压低)。目前已有充分资料证明,本型心绞痛是由于在冠状动脉狭窄的基础上,该支血管发生痉挛,引起一片心肌缺血所致。但冠状动脉造影正常的病人,也可由于该动脉痉挛而引起本型心绞痛,冠状动脉的痉挛可能与α肾上腺素能受体受到刺激有关,病人迟早会发生心肌梗塞。</p><p>  3、中间综合征(intermediate syndrome)亦称冠状动脉功能不全(coronary insufficiency)。指心肌缺血引起的心绞痛发作历时较长,达30min到1小时以上,发作常在休息时或睡眠中发生,但心电图、放射性核素和血清学检查无心肌坏死的表现。本型疼痛其性质是介于心绞痛与心肌梗塞之间,常是心肌梗塞的前奏。</p><p>  4、梗塞后心绞痛(postinfartionangina)在急性心肌梗塞后不久或数周后发生的心绞痛。由于供血的冠状动脉阻塞,发生心肌梗塞,但心肌尚未完全坏死,一部分未坏死的心肌处于严重缺血状态下又发生疼痛,随时有再发生梗塞的可能。</p><p>  (三)混合性心绞痛(mixed type angina pectoris)劳累性和自发性心绞痛混合出现,由冠状动脉的病变使冠状动脉血流贮备固定地减少,同时又发生短暂的再减损所致,兼有劳累性和自发性心绞痛的临床表现。有人认为这种心绞痛在临床上实甚常见。</p><p>  近年临床上较为广泛地应用<a target='_blank' href="http://tag.120ask.com/jibing/bwdxxjt/" style='color:#145b7d;text-decoration:underline;' >不稳定型心绞痛</a>(unstable angina pectoris)一词,指介于稳定型心绞痛与急性心肌梗塞和猝死之间的临床状态,包括了初发型、恶化型劳累性心绞痛,和各型自发性心绞痛在内。其病理基础是在原有病变上发生冠状动脉内膜下出血、粥样硬化斑块破裂、血小板或纤维蛋白凝集、<a target='_blank' href="http://tag.120ask.com/zhengzhuang/gzdmjl/" style='color:#145b7d;text-decoration:underline;' >冠状动脉痉挛</a>等</p><br /> </div> <div class="portlet" id="yw0"> <div class="portlet-content"> <div class="baike_dl"> <h3 class="ti">相关百科</h3> <div class="lists"> <span><a href='https://tag.120ask.com/jibing/lnrbyxxjt/' title='老年人变异型心绞痛'>老年人变异型心</a></span><span><a href='https://tag.120ask.com/jibing/xjgshxby/' title='心肌梗死后心包炎'>心肌梗死后心包</a></span><span><a href='https://tag.120ask.com/jibing/fstdtgxjgs/' title='非ST段抬高心肌梗死'>非ST段抬高心</a></span><span><a href='https://tag.120ask.com/jibing/wtxxjgs/' title='无痛性心肌梗死'>无痛性心肌梗死</a></span><span><a href='https://tag.120ask.com/jibing/wdxxjt/' title='稳定型心绞痛'>稳定型心绞痛</a></span><span><a href='https://tag.120ask.com/jibing/lnrwdxxjt/' title='老年人稳定型心绞痛'>老年人稳定型心</a></span><span><a href='https://tag.120ask.com/jibing/lnrbwdxxjt/' title='老年人不稳定型心绞痛'>老年人不稳定型</a></span><span><a href='https://tag.120ask.com/jibing/byxxjt/' title='变异型心绞痛'>变异型心绞痛</a></span><span><a href='https://tag.120ask.com/jibing/sxgxb/' title='猝死型冠心病'>猝死型冠心病</a></span><span><a href='https://tag.120ask.com/jibing/bwdxxjt/' title='不稳定型心绞痛'>不稳定型心绞痛</a></span><span><a href='//tag.120ask.com/zhengzhuang/xiongbt/' title='胸背痛'>胸背痛</a></span><span><a href='//tag.120ask.com/zhengzhuang/jiaolv/' title='焦虑'>焦虑</a></span><span><a href='//tag.120ask.com/zhengzhuang/kongju/' title='恐惧'>恐惧</a></span><span><a href='//tag.120ask.com/zhengzhuang/jinzhang/' title='紧张'>紧张</a></span><span><a href='//tag.120ask.com/zhengzhuang/fzba/' title='烦躁不安'>烦躁不安</a></span><span><a href='//tag.120ask.com/zhengzhuang/pfcb/' title='皮肤苍白'>皮肤苍白</a></span><span><a href='//tag.120ask.com/zhengzhuang/xiongtong/' title='胸痛'>胸痛</a></span><span><a href='//tag.120ask.com/zhengzhuang/xiongmen/' title='胸闷'>胸闷</a></span><span><a href='//tag.120ask.com/zhengzhuang/xmbq/' 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