基于心电向量理论的启发式心电图教学

临床医生对心电图(ECG)诊断技能的欠缺与传统ECG教学对心电向量理论的忽视不无关系。为契合提升临床医生ECG诊断能力的教学目标，提出建立基于心电向量理论的启发式ECG教学，并探讨了其具体实施策略。教学实施过程中，采用实践读图考核与问卷调查相结合的方式客观评价教学效果，发现启发式教学组的实践读图成绩和问卷调查分值均高于传统教学组。同时，分析了启发式ECG教学在实际实施过程中面临的问题，旨在优化这一教学模式。     

心电图诊断急性心肌梗死相关动脉的研究

心电图(ECG)检查在急性心肌梗死(AMI)诊断中具有重要的地位,被广泛应用于临床。ECG的变化有助于判断AMI时梗死相关动脉(IRA)的部位及指导AMI治疗。随着介入心脏病学的进展,特别是选择性冠状动脉造影的广泛应用,促进了冠心病ECG的研究,使ECG快速、无创地估测IRA得到较大的提高。     

冠状动脉内心电图的研究进展

本文介绍了40年以来冠状动脉内心电图(IC ECG)的简要发展史,主要基于血流储备分数(FFR)对心肌缺血的生理意义,回顾近年来IC ECG与FFR的相关性研究,提出IC ECG相较于FFR的优势,阐明IC ECG的临床应用价值.     

36例不典型急性心肌梗死的临床分析

目的总结急性心肌梗死（AMI）早期不典型心电图（ECG）改变与临床的诊断特点。方法回顾性分析36例临床确诊的AMI者在发病24h内早期不典型ECG,与各自发病前ECG进行对比分析总结。结果36例元典型AMI临床症状者19例（占53％）,有3个诊断特点和不典型ECG表现6个特点。结论不典型AMI的临床诊断应综合分析,部分AMI早期ECG表现虽不典型,但具有与AMI相关的固有特点,早期识别有助于诊断。     

围手术期老年患者发生心肌梗塞5例报告

手术前常规ECG正常的老年人在围手术期发生急性心肌梗塞的报导甚少,我院共遇5例报告如下: 例1 患者男性63岁,常规ECG正常,临床诊断:肝癌。术后28小时发生休克,ECG示急性右室、下壁心肌梗塞,抢救无效死亡。例2 患者男性,72岁,常规ECG大致正常,临床     

濒死心电图的分型与临床

目的探讨临床濒死心电图(Ag ECG)的常见类型及其相关的临床意义。方法对20例检出AgECG改变的心血管内科危重症者心电图(ECG)及临床资料进行回顾性分析。结果按Ag ECG改变特征可分为室性心动过速-心室颤动型、停搏型、阻滞型和混合型4种类型,以室性心动过速-心室颤动型和混合型最为多见,发生率分别为40%和30%,死亡率为15%和5%。结论及时的ECG检测和持续的心电监护可及早发现恶性心律失常的先兆,及时明确Ag ECG改变的类型,对临床及时有效的抢救治疗具有重要的意义。     

老年人的心电图

由于70岁以上人群的增加,估价有否心脏病及其严重程度的客观性非侵入性方法的重要性显得更为重要。ECG对病人无危险,费用较低,方法简单和可重复,有助于作一系列研究。要回答ECG在老年人中可作为心脏病的一个独立标记的价值问题时,必须考虑到:(1)在老年人中各种ECG异常的发生率;(2)老年人中的正常ECG标准;(3)与增龄相关的ECG异常的发生率;(4)ECG与临床心脏病的关连;(5)识别在统计学上与临床心脏病的存在有相关的特异性ECG异常。虽然ECG波形的幅度与持续时间随增龄而有     

等位性Q波对诊断急性心肌梗死的临床意义

急性心肌梗死(AMI)是临床心血管病急症,心电图(ECG)对其有重要的诊断价值。当患者有症状及酶学改变的情况下,ECG出现病理性Q波(宽度>0.04s,深度>1/4R波)常常是AMI的权威性诊断。但是经过大量ECG与尸检对比,发现病理性Q波作为透壁性心肌梗死(QMI)或非透壁心肌梗死(NQMI)的鉴别诊断依据,既不敏感,又不特异。近年来,国内外一些学者提出等位性Q波(相当Q波)的新概念,它有助于AMI的诊断。笔者在实际工作中,发现数例较典型的病例支持以上论述。1临床资料例1:70岁,男性,有心绞痛症状,STV1～V3弓背抬高,对照3d前ECG,R波幅度进行性下…     

完全性左束枝阻滞时左室肥厚心电图诊断标准的可靠性探讨

本文为进一步明确ECG诊断CLBBB患者左室肥厚的可靠性,结合ECG诊断标准和UCG对36例CLBBB患者进行了分析。其结果提示:常规诊断LVH的ECG标准和新近提出的ECG标准,对诊断伴CLBBB患者的LVH的价值是极其有限的,其敏感性或/和特异性差,尚不能作为临床运用和可靠指标。     

心电向量图在诊断心肌梗死中的优势

心电图(ECG)在临床上应用已逾百年历史,心电向量图(VCG)进入临床只有50余年。由于ECG掌握容易,诊断标准明晰,被人们的认知程度极高。但了解向量图的专业人员极少,导致了VCG检查有     

Electrocardiographic changes in cardiovascular abnormalities concomitant with gastrointestinal disease

Summary Abnormalities or peculiarities of the electrocardiogram are encountered frequently in patients with symptoms suggestive of disorder of the digestive system.1. The electrocardiogram may suggest that disease of the heart has led to disease or disorder of the digestive system, or vice versa.2. In others, the electrocardiogram may indicate disease or disorder of the heart that will be found to be unrelated to disease of the digestive system.3. The electrocardiographic changes can be related to disturbance of the autonomic nervous system, to proximity of the heart to the stomach or esophagus, or to the effects of drugs.4. Minor changes in the electrocardiogram are common in persons with gastrointestinal disorders and are without diagnostic significance.     

The relationship of low voltage on the electrocardiogram and chronic obstructive pulmonary disease

A retrospective analysis was performed to analyze the relationship between low voltage on the electrocardiogram and chronic obstructive pulmonary disease. Subjects were 250 patients who had both pulmonary function tests and an electrocardiogram at UMDNJ-John F. Kennedy Memorial Hospital from the years 1975–1980. Low voltage was detected in only 13 of 250 patients. An attempt to define the relationship between the incidence of low voltage on the electrocardiogram and the severity of airway obstruction, as judged by the reduction in the FEV₁, was unsuccessful. Concomitantly, a relationship could not be established between the incidence of low voltage and the degree of hyperinflation, as judged by the residual volume. In conclusion, the electrocardiographic evidence of low voltage does not represent either a sensitive or a specific finding for patients with chronic obstructive lung disease. It cannot be construed as either a useful or predictive parameter in the diagnostic evaluation of these patients.     

Thallium-201 myocardial imaging in evaluation of asymptomatic individuals with ischaemic ST segment depression on exercise electrocardiogram

Asymptomatic adults with normal physical examination, normal resting electrocardiogram, and normal routine laboratory evaluation who have a positive exercise electrocardiogram and abnormal exercise thallium-201 myocardial image have a very high probability of angiographically significant coronary artery disease. If, on the other hand, the exercise electrocardiogram is positive for "ischaemic" ST segment changes, but the exercise thallium image is normal, the probability for coronary disease is low. The exercise electrocardiogram combined with thallium-201 myocardial image are safe non-invasive methods which can be performed on an out-patient basis.     

An outbreak of Serratia marcescens in 14 adult cardiac surgical patients associated with 12-lead electrocardiogram bulbs.

Two clusters of Serratia marcescens in 14 adult cardiac surgical patients occurred over 10 months in an 876-bed teaching hospital. The 14 infections that were studied were as follows: one sternal and five leg incisions, five pneumonias, one bacteremia, one urinary tract infection, and one infected internal defibrillator site. The first cluster included four pneumonias, one urinary tract infection, and one bacteremia. Corrective actions were taken based on outbreak data through no source was identified. No further infections occurred during the following 2 months. The second cluster included one sternal and five leg incisions, an infected internal defibrillator incision site, and one pneumonia. Serratia marcescens was isolated from six electrocardiogram rubber welsh bulbs with sensitivities identical to patient isolates that indicated a common source outbreak in at least the second cluster of infections. Disposable electrocardiogram leads were introduced and the problem was resolved. We conclude that reusable electrocardiogram welsh bulbs are a vector for postoperative infections.     

Thallium-201 myocardial imaging in evaluation of asymptomatic individuals with ischaemic ST segment depression on exercise electrocardiogram.

Asymptomatic adults with normal physical examination, normal resting electrocardiogram, and normal routine laboratory evaluation who have a positive exercise electrocardiogram and abnormal exercise thallium-201 myocardial image have a very high probability of angiographically significant coronary artery disease. If, on the other hand, the exercise electrocardiogram is positive for "ischaemic" ST segment changes, but the exercise thallium image is normal, the probability for coronary disease is low. The exercise electrocardiogram combined with thallium-201 myocardial image are safe non-invasive methods which can be performed on an out-patient basis.     

Electrical remodeling in left ventricular hypertrophy—is there a unifying hypothesis for the variety of electrocardiographic criteria for the diagnosis of left ventricular hypertrophy?

Although electrocardiography has been used to estimate left ventricular hypertrophy and to obtain useful prognostic information in different clinical settings, its correlation with left ventricular mass is poor and, therefore, its sensitivity and specificity for the diagnosis of left ventricylar hypertrophy are low. Experimental work has demonstrated that the increase in voltage and duration of the QRS complex of the electrocardiogram are not only related to left ventricular mass but also to changes in the electrophysiological properties of the myocardium. Therefore, a new strategy is needed to use electrocardiography not to estimate left ventricular mass but aimed to add useful prognostic information.     

The electrocardiogram in ventricular tachycardias

The electrocardiogram, as much as the clinical examination, is a basic tool for the cardiologist. Technological advances have led to a certain lack of interest in learning to read the electrocardiogram, for which close analysis can allow precise diagnosis, notably in the field of cardiac rhythm disorders. This article concerns the electrocardiogram in ventricular tachycardias with two themes: differential diagnosis of wide QRS complex tachycardias and recognition of the site of origin of a ventricular tachycardia. "Fine" analysis of the electrocardiogram is not an intellectual "game". Actually, careful analysis of the 12 lead ECG allows exact and rapid diagnosis in a large majority of cases, distinguishing a ventricular tachycardia from a supraventricular tachycardia with conduction defect; the appropriate management can be selected without delay. At the same time, close reading of the electrocardiogram also allows the site of origin of a ventricular tachycardia to be recognised. Combining this information with elements of the patient's record can allow the arrhythmia to be related to a known pathology or to prompt a targeted aetiological investigation.     

2008年山东省克山病病区人群心电图调查分析

目的 观察山东省克山病病区受威胁人群心电图改变情况.方法 2008年,从邹城、泗水、滕州、沂水、平邑、五莲、莒县、青州8个县(市)选择21个病区村,对村民检查心电图,每个村抽查人数不少于100人,受检率不低于85%.结果 共对3378人进行心电图检查,460例心电图异常,异常心电图检出率为13.62%(460/3378),以T波改变、QRS波群低电压和ST-T改变较为常见,检出率分别为2.69%(91/3378)、1.92%(65/3378)和1.72%(41/3378);平邑县的异常心电图检出率最高,为26.76%(55/213),青州市次之,为21.50%(43/200),泗水县最低,为5.50%(12/218).结论 山东省克山病病区受威胁人群仍处于高异常心电图检出状态,心电图检查对于了解克山病的病情具有重要价值.     

Signal-averaged electrocardiography and the significance of late potentials in patients with "idiopathic" ventricular tachycardia: a review

High-frequency, low-amplitude electrical activity during and in continuation with the ventricular electrogram in sinus rhythm is now accepted as an indirect marker for reentrant pathways in ventricular muscle. Because the amplitude of these signals is low, much effort has recently been directed toward finding methods of recording these noninvasively. This essentially involves averaging the electrocardiogram, amplifying it, and filtering out the low frequency and nonrepetitive signals. This review discusses the methods presently available for signal-averaged electrocardiography and their background. The clinical application of signal-averaged electrocardiograms in patients with or suspected to have ventricular tachycardia is summarized. Data regarding the incidence of abnormal signal-averaged electrocardiography in patients with "idiopathic" ventricular tachycardia compared with normal subjects and patients with ventricular tachycardia related to ischemic heart disease are presented.     

A Comparative Analysis of Commercial Software for Signal-Averaged Electrocardiography

Background: Lack of standardization of software algorithms to identify the end of QRS for time-domain analysis of the signal-averaged electrocardiogram may limit the comparison of results obtained with different machines. Methods: To study this problem, 50 normal volunteers underwent signal-averaged electrocardiogram with ART 1200 EPX and Corazonix Predictor units in random sequence, collecting an equal number of beats. Data were analyzed with five different commercial softwares by ART and Corazonix. Results: Comparison of QRS duration, duration of low amplitude signals, and root mean square voltage of last 40 ms of QRS at two high-pass filter settings (25 and 40 Hz) showed significant differences among softwares. Conclusions: Standardization of software for time-domain analysis of the signal averaged electrocardiogram is warranted; until then, normal values for signal averaged electrocardiogram parameters will have to be appropriately selected for each study, according to the software utilized.