努力到感动自己，奋斗到无能为力。
温馨提示：本视频时长6分8秒
视频来源：YouTube.com
以下内容基于视频内容进行编辑以及拓展
6分钟，了解心绞痛
此音频是视频版的音频，可对照文章来收听。
以下中文翻译由笔者翻译，笔者不才，难免存在错误，如有，希望您留言指正，谢谢。
Angina comes from the latin angere, which means to strangle, and pectoris comes from pectus, meaning chest—so angina pectoris loosely translates to “strangling of the chest”, which actually makes a lot of sense, because angina pectoris is caused by reduced blood flow which causes ischemia to the heart muscle, or lack of oxygen to the heart, almost like the heart’s being strangled which causes terrible chest pain.
单词“Angina”取自拉丁文“angere”,意为“绞死”，而单词“Pectoris”取自“Pectus”，意为胸部--所以angina pectoris(心绞痛) 可以翻译成“胸部绞死”，所以实际上意思也差不多，因为心绞痛就是由于血液流通减少引发的心肌局部缺血和心脏缺氧，所以可以理解为心脏被严重的胸痛而绞死的意思。
Stable angina or chronic angina is the most common type of angina and it usually happens when the patient has greater than or equal to 70% stenosis, meaning 70% of the artery is blocked by plaque buildup.
稳定型心绞痛或者称为慢性心绞痛，是心绞痛最常见的形式。通常是由于患者70%或以上血管狭窄而引发的，意味着由于斑块堆积，患者有70%的动脉都被阻塞了。
This small opening that blood flows through might be enough to supply the heart during rest, but if the body demands more blood and oxygen, like during exercise or stressful situations, the heart has to work harder, and therefore needs more blood and oxygen itself.
在静息状态下，血流通过这个小口以满足心脏足够的供血。但如果机体需要更多的血供以及氧气时，像运动时或应激状态下，心脏不得不更多的需要工作更多，以获得血供和氧气。
It’s during these time of exertion or emotional stress that people with stable angina have chest pain, since the blood flow isn’t meeting the metabolic demands of the heart muscle, or myocardium.
在劳累或者情绪压力大的情况下，患稳定型心绞痛的患者会产生胸痛，这是由于血液供给并没有达到心肌的代谢要求。
But the pain usually goes away with rest.
但是一旦休息下来，疼痛就会消失。
In the majority of cases, the underlying cause of stable angina is atherosclerosis of one or more the coronary arteries—arteries supplying blood to the heart muscles.
在大多数案例中，稳定型心绞痛的潜在病因是由于一条或多条冠状动脉发生动脉粥样硬化造成的--这些冠状动脉为心肌提供血液。
Other heart conditions that might lead to stable angina are ones that cause a thickened heart muscle wall, which would require more oxygen.
其他会引发稳定型心绞痛的心脏问题是由于心肌过厚造成的，因为这会需要更多氧气供应。
This increase in muscle size can be due to hypertrophic cardiomyopathy from a genetic cause, or as a result from the heart having to pump against higher pressures, as is the case in aortic stenosis, which is a narrowing of the aortic valve, or hypertension.
心肌厚度的增加可能是由于遗传性肥厚性心肌病，或者心脏在高血压下泵血造成的。同样的，主动脉瓣狭窄，一种主动脉瓣缩小的疾病，或者高血压也会引发相同状况。
These larger, thicker heart muscles require more oxygen, and if the patients can’t meet increasing demands, they feel pain in the form of angina.
这些大而厚的心肌需要更多的氧气，所以如果患者无法满足增加的需求，他们会感到心绞痛。
Whatever the case, the heart needs blood, and if we look at the heart wall, there’s three layers—the outermost layer, the epicardium, then the myocardium in the middle, and the endocardium inside the heart.
无论在何种案例下，心脏都是需要血供的，如果我们观察心脏壁，会发现心脏壁共有三层--外层，也就是心外膜；中层的心肌，然后在心脏最里面的心内膜。
The coronary arteries start up in the epicardium,and then dive down and supply all the heart tissue.
冠状动脉起于心外膜，然后向下深入到所有心脏组织。
If blood flow’s reduced or the myocardium is thicker, blood has a harder time reaching this deeper layer just under the endocardium, called the subendocardium.
如果血流量减少，或者心肌变厚，那么血液到达心内膜下的最深层就会变得非常困难。而最深层的位置又被称为心内膜下层。
Therefore the classic finding with angina is subendocardial ischemia, meaning less oxygen is reaching the region just under the endocardium.
因此心绞痛的典型现象就是心内膜下层局部缺血，意味着只有很少的氧气到达心内膜下层。
This ischemia is thought to trigger release of adenosine, bradykinin, and other molecules that stimulate nerve fibers in the myocardium that result in the sensation of pain.
这种缺血被认为是释放环腺苷酸、缓激肽以及其他分子的诱因，这些分子会刺激心肌中的神经纤维造成痛感。
That chest pain is usually described as feeling like pressure or squeezing and it can radiate to the left arm, jaw, shoulders, and back, and sometimes is accompanied by shortness of breath and diaphoresis or sweating.
胸痛通常会被描述成压迫感或紧缩感，可能放射到身左臂、下颚、肩膀以及后背；有时这个症状还会伴有气短以及出汗。
Usually the pain and symptoms last less than 20 minutes and subside after the exertion or stress is taken away, and therefore the heart muscle isn’t demanding as much blood.
通常疼痛和相应症状持续少于20分钟，并在劳累或压力减退后逐渐缓解，因此心肌不需要更多的血供。
Now, unlike stable angina which describes when patients have pain only during periods of exertion or stress, but not during rest,there is also unstable angina which is when patients have pain during exercise or stress as well as during rest—it never really goes away.
稳定型心绞痛被描述为患者只有在劳累或压力的情况下产生，而不会在休息中产生，但是也存在不稳定型心绞痛，患病的病人无论在劳累或压力下，还是在休息中都会发病--疼痛不会消失。
Unstable angina is usually caused by rupture of atherosclerotic plaque with thrombosis, meaning a blood clot forms on top of a mound of plaque.
不稳定型心绞痛通常是由于动脉粥样硬化斑块破裂形成血栓引起的，也就是说血栓在斑块的顶部形成。
Although the occlusion might not block the entire vessel, there is now even less room left for blood to flow by, and the heart tissue is starting to feel starved for oxygen even while pumping at a normal rate.
尽管斑块并没有阻塞整个血管管腔，但留给血液通过的空间也十分的狭窄，因此心脏组织即使仍然以正常的速度跳动，但是已经开始需要大量的氧气。
Unstable angina, for the same reason as stable angina, involves subendocardial ischemia and it should be treated as an emergency, because patients are at a high risk of progressing to myocardial infarction, or heart attack.
和稳定型心绞痛一样，不稳定型心绞痛涉及到心内膜下层缺血的问题，不同的是不稳定型心绞痛是紧急情况，因为患者很有可能因此而发生心肌梗死或者心脏病。
The key distinction is that unstable angina means that the heart tissue is alive but ischemic or starving for oxygen, whereas myocardial infarction means that the areas of heart tissue have already begun to necrose or die.
二者之间的关键区别是，在不稳定型心绞痛发病时，心脏组织还是活的，只是缺血或者需要更多氧气，但是在心肌梗死发病时，心脏组织已经开始衰竭甚至坏死。
Now a third type of angina is vasospastic angina, also known as prinzmetal angina, and patients may or may not also have atherosclerosis.
第三种心绞痛是血管痉挛性心绞痛，也被称为“prinzmetal angina”，患者可能有或没有动脉粥样硬化症。
Ischemia, and resulting chest pain is due to coronary artery vasospasms, meaning the smooth muscles around the arteries constrict extremely tightly and reduce blood flow enough to cause ischemia.
局部缺血和胸痛都是因为冠状动脉血管痉挛，这就意味着血管周围的平滑肌突然收紧，减少血流量，造成局部缺血。
Episodes of vasospastic angina don’t correlate with exertion and can happen anytime, including at rest.
血管痉挛性心绞痛与劳累没有直接关系，也会在任何时期发病，包括在休息的时候。
The underlying mechanism causing
vasospasms isn’t well understood,but likely involves vasoconstrictors like platelet thromboxane A2.
引起血管痉挛的潜在机制直到现在还十分不清晰，但是很可能与血小板凝血氧烷A2等血管收缩剂有关。
Unlike both stable and unstable angina, in this case the coronary artery’s constricted so severely that all layers of the heart wall being supplied are affected, therefore it’s referred to as transmural ischemia.
与稳定型心绞痛和不稳定型心绞痛不同，在血管痉挛性心绞痛中，冠状动脉收缩过于严重，导致心脏壁全层的血供都受到影响，因此这种情况也被称为贯壁性缺血。
在人民卫生出版社第八版内科学中：
血管痉挛性心绞痛，也称变异性心绞痛，最早是于1959年由prinzmetal首先提出，在静息情况下发生，无体力劳动或情绪激动等诱因，常常伴随一过性ST段抬高或压低，冠状动脉造影证实一过性冠状动脉痉挛存在。
Alright, so if we line these three up side-to-side, there’s some important clinical similarities and differences.
如果我们把这三种心绞痛放在一起对比，我们就能看到它们在临床上的一些重要相似点和不同点。
First, it’s super important to remember that in each case, the injury to cardiomyocytes isn’t permanent, meaning it’s reversible and the
cardiomyocytes don’t die (which is how this differs from myocardial infarction).
首先我们需要牢记的要点是，在每一种情况下，心肌细胞的损伤并不是永久性的，这意味着心肌细胞的损伤是可逆的以及不会轻易死亡（这是与心肌梗死最大的不同）。
On an electrocardiogram, or ECG, both stable and unstable angina show an ST-segment depression since ischemia’s limited to the subendocardium.
在心电图（ECG）中，稳定型和不稳定型心绞痛都会显示ST段压低，这是由于心内膜下层缺血造成的。
In contrast, vasospastic angina shows ST-segment elevation due to transmural ischemia.
相反，血管痉挛性心绞痛会显示ST段抬高，这是因为贯壁性缺血的存在。
Rest tends to relieve stable angina, whereas unstable angi na and vasospastic angina canoccur anytime, including at rest.
稳定型心绞痛会在休息时缓解，但是不稳定型心绞痛和血管痉挛性心绞痛可以在任何时间发作，包括休息的时候。
In terms of medications, all three can be treated with Nitroglycerin which is a vasodilator that increases blood vessel diameter to allow more blood flow.
在药物治疗方面，以上三种心绞痛都可以借助硝酸甘油治疗。硝酸甘油是一种血管舒张剂，可以增大血管直径，进而让更多的血液通过。
In addition, vasospastic angina also responds to calcium channel blockers.
此外，血管痉挛性心绞痛也可以通过钙通道阻断剂治疗。
参考资料：
人民卫生出版社第八版内科学，主编葛均波，徐永健
联系客服
