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冠心病、心绞痛与心肌梗死

已审核发布 / Reviewed & published · 裁定 approved
Coronary heart disease, angina & MI审核 medical-reviewer· 2026-07-04· 引用核验 2026-07-04

先把三个词理顺​

“冠心病”“心绞痛”“心梗”在生活里常被混着说，但它们其实指的是不同层次的东西：一个是疾病，一个是症状，一个是急性事件。理清它们，才能在关键时刻做出正确判断。

冠心病（coronary heart disease，CHD冠心病 · Coronary heart diseaseCHD/ˈkɔːrənəri hɑːrt dɪˈziːz/冠状动脉粥样硬化导致心肌供血不足所引起的心脏病，可表现为心绞痛、心肌梗死等。Heart disease resulting from insufficient blood supply to the myocardium due to atherosclerosis of the coronary arteries; may present as angina or myocardial infarction.🧩 词根拆解 / word rootscoron-冠、王冠（冠状动脉像王冠一样环绕心脏） · crown (the arteries encircle the heart like a crown)拉丁语 corona 王冠＋-ary…的（形容词后缀） · adjective suffix，缩写 CHD）是病——为心脏自身供血的冠状动脉（coronary artery，Coronary artery冠状动脉 · Coronary artery/ˈkɔːrənəri ˈɑːrtəri/从主动脉根部发出、环绕并深入心脏、专门为心肌自身供应含氧血液的动脉；一旦被斑块阻塞，就可能引发冠心病或心肌梗死。An artery arising from the root of the aorta that encircles and penetrates the heart to supply oxygen-rich blood to the heart muscle itself; blockage can cause coronary heart disease or heart attack.🧩 词根拆解 / word rootscoron-冠、王冠（冠状动脉像王冠一样环绕心脏） · crown (the arteries encircle the heart like a crown)拉丁语 corona 王冠＋-ary…的（形容词后缀） · adjective suffix＋artery动脉 · artery希腊语 artēria）因动脉粥样硬化（atherosclerosis，Atherosclerosis动脉粥样硬化 · Atherosclerosis/ˌæθəroʊskləˈroʊsɪs/含胆固醇的脂质与炎症细胞在动脉内膜沉积、逐渐形成斑块使管腔狭窄、血管壁变硬的慢性过程。A chronic process in which cholesterol-rich lipids and inflammatory cells accumulate in the arterial intima, gradually forming plaques that narrow the lumen and stiffen the vessel wall.🧩 词根拆解 / word rootsathero-粥样、脂糊状（指斑块柔软的脂质核） · gruel/porridge (the soft fatty core)希腊语 athērē 粥/糊＋scler(o)-硬化、变硬 · hardening希腊语 sklēros 硬＋-osis（病理性）状态、过程 · abnormal condition/process希腊语 -ōsis）而变窄，导致心肌（myocardium，Myocardium心肌 · Myocardium/ˌmaɪəˈkɑːrdiəm/心壁中间厚厚的肌肉层，通过收缩和舒张把血液泵出心脏；它像身体其他肌肉一样，需要持续的含氧血液供应才能工作。The thick muscular middle layer of the heart wall that contracts and relaxes to pump blood out of the heart; like any muscle it needs a constant supply of oxygen-rich blood.🧩 词根拆解 / word rootsmyo-肌肉 · muscle希腊语 mys 肌肉＋cardi-心 · heart希腊语 kardia 心＋-um（解剖结构名词后缀） · noun suffix (anatomical structure)）供血不足。[1]Tier 3American Heart Association et al. About Heart Attacks --- Heart Attack Symptoms, Risk, and Recovery. 2024https://www.heart.org/en/health-topics/heart-attack/about-heart-attacks 它属于动脉粥样硬化性心血管疾病（atherosclerotic cardiovascular disease，ASCVD动脉粥样硬化性心血管疾病 · Atherosclerotic cardiovascular diseaseASCVD/ˌæθəroʊskləˈrɒtɪk ˌkɑːrdioʊˈvæskjələr/由动脉粥样硬化引起的一类疾病的总称，包括冠心病、缺血性卒中、外周动脉疾病等。An umbrella term for diseases caused by atherosclerosis, including coronary heart disease, ischaemic stroke, and peripheral artery disease.）的一种。

缺血：一切的核心​

当冠状动脉因斑块变窄，流向心肌的血液（以及其中的氧气）就可能不够用——这种“供血/供氧不足”的状态叫缺血（ischemia，Ischemia (ischaemia)缺血 · Ischemia (ischaemia)/ɪsˈkiːmiə/组织的血液供应（以及随之而来的供氧）不足以满足其代谢需要的状态；在心脏，即流向心肌的血流不足。它是心绞痛与心肌梗死背后的共同机制。A state in which the blood supply to a tissue—and thus its oxygen delivery—is insufficient for its metabolic needs; in the heart, insufficient blood flow to the myocardium. It is the common mechanism underlying angina and myocardial infarction.🧩 词根拆解 / word rootsisch-阻滞、抑制（血流被“拦住”） · restraining/holding back希腊语 ischein 抑制/拦住＋-(a)emia血、血液（的状态） · blood (condition of)希腊语 haima 血）。心绞痛正是心肌在缺血时发出的“求救信号”：心肌得不到足够的含氧血液。[2]Tier 3American Heart Association et al. Angina (Chest Pain). 2024https://www.heart.org/en/health-topics/heart-attack/angina-chest-pain

可以打个比方：冠状动脉像给心肌供水的水管，斑块像水管里逐渐结的水垢。 平时水量勉强够用；一旦需求上升（如爬楼、情绪激动），变窄的“水管”就送不上足够的血，心肌“喊渴”，于是出现胸痛。

心绞痛（angina）：是症状，不是病​

心绞痛（angina，Angina (angina pectoris)心绞痛 · Angina (angina pectoris)/ænˈdʒaɪnə/因心肌得不到足够的含氧血液（缺血）而产生的胸部压迫、紧缩或疼痛感，可放射到肩、臂、颈、下颌、上腹或背部。它是一种症状（通常提示冠心病），而非一种独立疾病；分稳定型与不稳定型。Chest pressure, tightness, or pain caused by the heart muscle not getting enough oxygen-rich blood (ischemia), which may radiate to the shoulder, arm, neck, jaw, upper abdomen, or back. It is a symptom (usually of coronary heart disease), not a disease in itself; classified as stable or unstable.🧩 词根拆解 / word rootsangina绞窄、勒紧感（源于“扼喉”之意） · a choking/strangling sensation拉丁语 angere 扼、勒＋pectoris胸的（“angina pectoris”即“胸部绞痛”） · of the chest拉丁语 pectus 胸）是一种症状，不是一种独立的疾病——它是心脏出问题（通常就是冠心病）的信号。[2]Tier 3American Heart Association et al. Angina (Chest Pain). 2024https://www.heart.org/en/health-topics/heart-attack/angina-chest-pain 典型表现是胸部的压迫、紧缩或疼痛感，可能放射到肩、臂、颈、下颌、上腹或背部。[2]Tier 3American Heart Association et al. Angina (Chest Pain). 2024https://www.heart.org/en/health-topics/heart-attack/angina-chest-pain[3]Tier 1Gulati, Martha et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline for the evaluation and diagnosis of chest pain: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021doi:10.1161/CIR.0000000000001029

医生会重点判断心绞痛是稳定型还是不稳定型。[2]Tier 3American Heart Association et al. Angina (Chest Pain). 2024https://www.heart.org/en/health-topics/heart-attack/angina-chest-pain 稳定型心绞痛较可预测（例如总在类似的用力程度下出现、休息后缓解）；而如果是不稳定型，可能需要紧急救治，以设法防止发展成心肌梗死。[2]Tier 3American Heart Association et al. Angina (Chest Pain). 2024https://www.heart.org/en/health-topics/heart-attack/angina-chest-pain 换句话说，不稳定型心绞痛是一记红色警报。

心肌梗死（MI / heart attack）：血流被切断，心肌开始坏死​

心肌梗死（myocardial infarction，MI心肌梗死 · Myocardial infarctionMI/ˌmaɪəˈkɑːrdiəl ɪnˈfɑːrkʃən/俗称“心脏病发作”（heart attack）：流向一部分心肌的血流被减少或阻断（多因斑块破裂后形成血栓突然堵塞冠状动脉），若持续过久，该部分心肌因缺血缺氧而坏死。是分秒必争的急症。Commonly called a 'heart attack': blood flow to part of the heart muscle is reduced or blocked (usually when a ruptured plaque triggers a clot that suddenly occludes a coronary artery), and if this lasts too long that muscle dies from lack of oxygen. A time-critical emergency.🧩 词根拆解 / word rootsmyo-肌肉 · muscle希腊语 mys 肌肉＋cardi-心 · heart希腊语 kardia 心＋-al…的（形容词后缀） · adjective suffix＋infarct-梗死（因供血受阻而形成的一片坏死组织） · a plug of dead tissue from an obstructed blood supply拉丁语 infarcire 塞入、填塞＋-ion…的过程/结果（名词后缀） · process/result (noun suffix)，缩写 MI，俗称 heart attack）发生在流向心肌的血流被减少或阻断的时候：冠状动脉被斑块（脂质、胆固醇等堆积形成）严重堵塞，若血流被中断得太久，得不到含氧血的那部分心肌就会开始坏死。[1]Tier 3American Heart Association et al. About Heart Attacks --- Heart Attack Symptoms, Risk, and Recovery. 2024https://www.heart.org/en/health-topics/heart-attack/about-heart-attacks

它与你在上一课学过的“斑块破裂与血栓”直接相连：多数心梗是原本狭窄的斑块破裂、随即在破口处形成血栓（血凝块）、突然把血管堵死所致。[1]Tier 3American Heart Association et al. About Heart Attacks --- Heart Attack Symptoms, Risk, and Recovery. 2024https://www.heart.org/en/health-topics/heart-attack/about-heart-attacks 这也是为什么心梗常常“说来就来”。

关键在于时间：血流中断得越久，坏死的心肌越多。因此心梗是分秒必争的急症——快速行动可以挽救生命。[4]Tier 3American Heart Association et al. Warning Signs of a Heart Attack. 2024https://www.heart.org/en/health-topics/heart-attack/warning-signs-of-a-heart-attack

稳定的一端 vs 急性的一端​

把冠心病想成一条谱系会更清楚：

  • 慢性、稳定的一端：慢性冠脉疾病（chronic coronary disease，缩写 CCD）——涵盖阻塞性或非阻塞性冠脉病变、既往心梗或血运重建后的稳定状态，以及慢性心绞痛综合征等。[5]Tier 1Virani, Salim S. et al. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA guideline for the management of patients with chronic coronary disease: a report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation 2023doi:10.1161/CIR.0000000000001168 这一端相对可控、可预测。
  • 急性的一端：急性冠脉综合征（acute coronary syndrome，ACS急性冠脉综合征 · Acute coronary syndromeACS/əˈkjuːt ˈkɔːrənəri ˈsɪndroʊm/冠状动脉内急性血栓性闭塞引起的一组急性临床表现的总称，包括 ST 段抬高型心肌梗死（STEMI）、非 ST 段抬高型心肌梗死（NSTEMI）和不稳定型心绞痛。An umbrella term for the acute clinical presentations caused by acute thrombotic occlusion of a coronary artery, including ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI) and unstable angina.🧩 词根拆解 / word rootsacute急性的、突然的 · sharp/sudden拉丁语 acutus 尖锐的＋coron-冠、王冠（冠状动脉） · crown (the coronary arteries)拉丁语 corona 王冠＋syndrome综合征（同时出现的一组表现） · a set of features running together希腊语 syn- 一起 + dromos 奔跑，缩写 ACS）——由冠脉血流突然明显减少引起的一组急症，从不稳定型心绞痛到心肌梗死。胸痛是 ACS 男女患者最常见的症状。[3]Tier 1Gulati, Martha et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline for the evaluation and diagnosis of chest pain: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021doi:10.1161/CIR.0000000000001029 这一端是急诊、要命的。

简单记：稳定 = 门诊慢慢管；急性 = 立刻打急救电话。

警示症状：出现这些，别硬扛​

美国心脏协会（AHA）列出的心脏病发作警示症状包括：[4]Tier 3American Heart Association et al. Warning Signs of a Heart Attack. 2024https://www.heart.org/en/health-topics/heart-attack/warning-signs-of-a-heart-attack

  • 胸部不适：胸部中央出现不舒服的压迫感、紧缩感、饱胀感或疼痛，可能持续，也可能反复出现。[4]Tier 3American Heart Association et al. Warning Signs of a Heart Attack. 2024https://www.heart.org/en/health-topics/heart-attack/warning-signs-of-a-heart-attack
  • 上半身不适：一侧或双侧手臂、背部、颈部、下颌或胃部（上腹部）的疼痛或不适。[4]Tier 3American Heart Association et al. Warning Signs of a Heart Attack. 2024https://www.heart.org/en/health-topics/heart-attack/warning-signs-of-a-heart-attack[3]Tier 1Gulati, Martha et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline for the evaluation and diagnosis of chest pain: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021doi:10.1161/CIR.0000000000001029
  • 气短：可以伴随胸部不适，也可以单独出现。[4]Tier 3American Heart Association et al. Warning Signs of a Heart Attack. 2024https://www.heart.org/en/health-topics/heart-attack/warning-signs-of-a-heart-attack
  • 其他信号：冒冷汗、恶心、头晕（眩晕）、异常疲惫，以及心跳不规律。[4]Tier 3American Heart Association et al. Warning Signs of a Heart Attack. 2024https://www.heart.org/en/health-topics/heart-attack/warning-signs-of-a-heart-attack

需要特别提醒：女性可能出现胸痛，但也更容易出现一些**不那么“典型”**的症状，如气短、恶心、呕吐、后背/肩/手臂疼痛以及异常乏力。[4]Tier 3American Heart Association et al. Warning Signs of a Heart Attack. 2024https://www.heart.org/en/health-topics/heart-attack/warning-signs-of-a-heart-attack 正因如此，容易被误当成“胃不舒服”或“累着了”而延误。

冠状动脉被血栓堵塞导致下游心肌缺血/梗死，并列出心脏病发作的警示症状

图 · 斑块破裂处形成血栓、突然堵死冠状动脉，下游心肌因缺血而坏死；出现胸痛或压迫感、放射至手臂/下颌/背、气短、冷汗/恶心等警示症状时，应立即拨打 120 / 911。[4]Tier 3American Heart Association et al. Warning Signs of a Heart Attack. 2024https://www.heart.org/en/health-topics/heart-attack/warning-signs-of-a-heart-attack

何时必须立即拨打急救电话​

出现上述警示症状时，不要等待、不要自我说服“忍一忍就过去”。请立即拨打当地急救电话：中国为 120、美国为 911。[4]Tier 3American Heart Association et al. Warning Signs of a Heart Attack. 2024https://www.heart.org/en/health-topics/heart-attack/warning-signs-of-a-heart-attack[6]Tier 3Beijing United Family Hospital et al. How to Call an Ambulance in Beijing. 2024https://beijing.ufh.com.cn/7397/health-information/articles/how-to-call-an-ambulance-in-beijing?lang=en 指南明确建议，对急性胸痛应尽快评估，并教育公众拨打 911（在中国即 120）呼叫急救医疗服务、由救护车送往最近的急诊。[3]Tier 1Gulati, Martha et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline for the evaluation and diagnosis of chest pain: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021doi:10.1161/CIR.0000000000001029

为什么优先叫救护车、而不是自己开车去医院？因为拨打急救电话通常是获得救命治疗最快的方式——急救人员到场后即可开始救治，也能更快把你送到医院。[4]Tier 3American Heart Association et al. Warning Signs of a Heart Attack. 2024https://www.heart.org/en/health-topics/heart-attack/warning-signs-of-a-heart-attack 分秒必争，快速行动能挽救生命。[4]Tier 3American Heart Association et al. Warning Signs of a Heart Attack. 2024https://www.heart.org/en/health-topics/heart-attack/warning-signs-of-a-heart-attack

⚕️ 本内容仅供健康科普与学习，不能替代专业医疗建议、诊断或治疗。紧急情况请立即拨打急救电话。

参考文献 / References​

  1. Tier 3American Heart Association et al. About Heart Attacks --- Heart Attack Symptoms, Risk, and Recovery (2024) · link
  2. Tier 3American Heart Association et al. Angina (Chest Pain) (2024) · link
  3. Tier 1Gulati, Martha et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline for the evaluation and diagnosis of chest pain: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation (2021) · doi:10.1161/CIR.0000000000001029
  4. Tier 3American Heart Association et al. Warning Signs of a Heart Attack (2024) · link
  5. Tier 1Virani, Salim S. et al. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA guideline for the management of patients with chronic coronary disease: a report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation (2023) · doi:10.1161/CIR.0000000000001168
  6. Tier 3Beijing United Family Hospital et al. How to Call an Ambulance in Beijing (2024) · link