巨R波形ST段抬高6例

本文收集宁波大学医学院附属医院6例心电图呈巨R波形ST段抬高的临床案例,结合临床病史及相关影像学、实验室检查结果,分析探讨ST段抬高的机制及原因,发现巨R波形ST段抬高可见于急性冠脉综合征、急性大面积脑梗死、严重脑挫裂伤、脑出血、嗜铬细胞瘤危像、重症心肌炎等.     

室性早搏呈典型巨R波型ST段抬高一例

巨R波型ST段抬高是心肌缺血时心电图表现的一种，较为少见但是非常重要的类型，多见于窦性心律时。近期遇到一例心绞痛发作时，动态心电图检测到室性早搏（室早）呈典型巨R波型ST段抬高的患者，报道如下。     

动态心电图记录典型“巨R波形”ST段抬高2例

例1患者男性，56岁。平素体健，无心血管疾病。以外伤后右肩疼痛、肿胀、活动受限1h于2004年4月11日入院。入院前患者骑车意外摔倒，右肩部着地。当时无昏迷、右肩部疼痛，活动时痛剧，无出血，面颊及双手背出血、疼痛。体检：神志清，BP170／110mmHg。右锁骨中段外1／3处不连续，可及骨擦感，肩关节外展、上举受限。X光片示右锁骨骨折。入院后予抗炎、止血、锁骨固定带治疗，并行切开复位内固定术。术后三日出现心慌、胸闷，夜间明显。心电图检查（图略）示：窦性节律，心电图正常。     

“巨R波形”ST段抬高变异型心绞痛1例

1临床资料患者,男性,58岁,以反复胸骨后闷痛2年,加重2d入院。近2d每天发作2~3次,多在凌晨3时左右发作,发作时伴出汗、胸闷、气短,每次持续10min余,含服硝酸甘油可缓解。既往否认高血压、糖尿病病史。吸烟史30年,10支/d。入院查体:BP:140/90mmHg,双肺听诊正常,心界不大,心率70次/min,律齐,心尖部可闻及2/6级收缩期杂音。血脂、血糖、离子、心肌酶均在正常范围。静息心电图大致正常(图1A)。心绞痛发作时心图1静息及心绞痛发作时心电图特征电图表现为Ⅱ、Ⅲ、aVF、V6ST段均呈巨R波形"抬高。QRS波群与ST-T融合呈峰尖底宽的三角形,其余导…     

“巨R波形”ST段抬高的特性及其临床意义

以往根据心电图出现病理性Q波、ST段移位及T波改变 ,将心肌梗死 (MI)分为急性、亚急性和陈旧性 3个时期。近年发现 ,MI早期心电图多不能显示 (MI)典型图形 ,往往只有ST T改变。本文旨在探讨超急性期MI罕见的“巨R波形”ST段抬高的特性及其临床意义。1　“巨R波形”(GRWS)ST段抬高的特性1993年Madias首先提出GRWSST段抬高的概念 ,其常见于MI超急性期 ,尤其是前壁MI[1] ,偶见于下壁[2 ] 。此外 ,还可见于心肌急性严重缺血时 ,如不稳定型、变异型心绞痛[3] 、运动负荷试验、心房起搏及PTCA术中[4、5] 。GRWSST段抬高的心电…     

急性严重心肌缺血致巨R波形ST段抬高2例分析

1病例介绍 例1：患者男性,59岁。反复胸骨后疼痛半年来院就诊。常于夜间睡眠时突发胸骨后疼痛呈压榨感,无放射痛,持续5～10分钟自动缓解。有时伴有大汗淋漓及恶心感。否认高血压病及糖尿病史。体检：BP130／82mmHg,心率75次／分,律齐,未闻及病理性杂音。胸片及超声心动图检查无殊。     

“巨R波形”ST段抬高型心肌梗死合并三支阻滞1例

患者女性，69岁。因发作性胸闷、胸痛3天，持续不缓解3h入院。临床诊断：急性前壁心肌梗死。实验室检查：CK1472u／l，CK—MB59 u／l。入院后记录到心电图（图1A）示：PⅡ，Ⅲ，aVF直立，PaVR倒置，心率88次／分，P—R间期0．22s；Ⅰ导联呈Rs型，aVL导联呈qR型，Ⅱ、Ⅲ、aVF导联呈rS型（SⅢ〉SⅡ），电轴左偏-58°；V1导联呈R型，时限0．12s，V2-V5导联R波与ST—T融合形成“巨R形”ST段抬高。     

“巨R波形”ST段抬高并室性心律失常一例

患者男性,49岁。因阵发性心前区疼痛就诊。心电图示T波:V1~V3高耸。同步三导联动态心电图示间歇性CM5导联QRS波群与抬高的ST段由低到高逐渐融为一体,形成单一三角形宽QRS波,即“巨R波形”ST段抬高。入院查心肌酶正常,扩血管治疗好转。结论:心肌缺血周围阻滞所致“巨R波形”ST段抬高。     

"巨R波形"ST段抬高的特性及其临床意义

以往临床上根据心电图出现病理性Q波、ST段移位及T波改变,将心肌梗死分为急性、亚急性和陈旧性3个阶段。但近年来发现,在本病早期,心电图多不能显示心肌梗死的典型图形,往往只有ST-T改变。本文旨在探讨超急性期心肌梗死罕见的“巨R波形”ST段抬高(简称巨R形ST段)的特性及其临床意义。     

巨R波型ST段抬高的变异型心绞痛1例

患者男性，53岁。因近5天来发作2次胸闷、胸痛伴呼吸困难及大汗而入院。每次均于搬东西时诱发，胸痛时向背部放射，含服速效救心丸缓解。体检：血压正常，双肺呼吸音清晰、心律齐，各瓣膜区听诊未闻及病理性杂音。心肌酶谱正常。超声心动描记术检查示：心内结构正常，三尖瓣少至中量返流。常规心电图正常。行24h动态心电图检查中，于清晨5：20再次发作胸痛时示：窦性心律；室性期前收缩；Ⅱ、Ⅲ、aVF、V3～V6导联的QnS波群与ST—T融合，J点消失，     

Ischemic pseudo-normalization of T waves and ST segment

The development of acute myocardial ischaemia in a territory with baseline repolarization abnormalities can be reflected by transient pseudo-normalisation of the T wave and/or ST segment. These repolarization abnormalities can occur spontaneously, during a stress test or during of an isoproterenol test. Clinicians should be familiar with these unusual electrocardiographic changes of acute ischaemia, which require appropriate surveillance and treatment.     

Stress-induced ST segment shift in leads V3R and V4R after acute myocardial infarction.

A total of 107 patients with acute myocardial infarction underwent a dobutamine stress test and received increasing doses of the drug (5, 10, 15, 20, and up to 40 micrograms/kg/min). Coronary angiography was performed within the first month. The 12 conventional ECG leads plus the right chest leads V3R and V4R were recorded under basal conditions and after each dose of dobutamine. In 51 patients (group A) there was an ST shift greater than or equal to 0.5 mm in the right chest leads, with two different patterns: rightward (V2 less than V1 less than V3R V less than V4R) (n = 26) and leftward (V2 less than V1 less than V3R greater than V4R) (n = 25). In 56 patients (group B) no ST shift in the right chest leads was induced. An ST segment elevation greater than or equal to 0.5 mm in V4R was 43% sensitive and 86% specific for the detection of proximal right coronary artery disease. Four subgroups were established in group A: A1R, rightward ST elevation (n = 23); A1L, leftward ST elevation (n = 12); A2R, rightward ST depression (n = 3); and A2L, leftward ST depression (n = 13). Group A1R had predominantly inferior infarcts and right coronary artery stenoses, group A1L had predominantly anterior infarcts and left anterior descending coronary stenoses, and group A2L had posteroinferior infarcts and right or left circumflex stenoses, all of them with low sensitivity (less than 50%) and high specificity (greater than 87%) for a such diagnosis.(ABSTRACT TRUNCATED AT 250 WORDS)     

急性心肌梗死左主干与前降支近段病变心电图ST段压低的对照分析

目的探讨12导联心电图ST段压低在急性心肌梗死左主干与前降支近段病变鉴别中的价值。方法选取因急性心肌梗死住院的患者,依冠状动脉造影结果,分为冠状动脉左主干病变(LM组)和左前降支近端病变(LAD组)。回顾性分析患者入院即刻的12导联心电图,比较两组ST段压低改变的特点。结果入选符合标准的患者共74例,LM组15例,LAD组59例。LM组Ⅰ、Ⅲ、aVL和aVF导联ST段压低比例显著高于LAD组(P均<0.05),V2～6ST段压低比例两组亦有差异(P均<0.01)。同时,V2～6导联ST段改变值两组亦有差异。多元分析表明Ⅲ、V2和V6导联ST段压低对急性左主干病变有预测价值(P均<0.001),其诊断的敏感度为26.7%、特异度100%、阳性预测值100%和准确度85.1%。结论Ⅲ、V2和V6导联ST段压低有助于鉴别急性左主干与左前降支近段病变。     

心房颤动伴长R-R间距的动态心电图及临床分析

目的采用动态心电图（DCG）分析心房颤动（Af）伴长R-R间距（〉2.0s）、交接区（或室性）逸搏及逸搏心律,以探讨其合并房室阻滞（AVB）的诊断价值及临床意义。方法对动态心电图（DCG）记录的201例中〉2.0s的长R-R间距、交接区（或室性）逸搏及逸搏心律出现的时间是否与睡眠相关,分为睡眠相关组（A组45例）及非睡眠相关组（B组156例）。结果两组间日间及夜间平均心室率、最大及最小平均心室率,B组明显小于A组。长R-R间期次数及最长R-R间期均值,B组均大于A组（P〈0.05）。结论Af伴长R-R间距、交接区（或室性）逸搏及逸搏心律若与睡眠相关,视此AVB的临床意义不大;而与睡眠无关时,常有头晕、黑朦,病情危重,应视此AVB有临床意义,及时提请临床医师处理。     

Propranolol toxicity presenting with early repolarization, ST segment elevation, and peaked T waves on the ECG

A 58-year-old man presented stating that he had voluntarily ingested eight 80-mg propranolol tablets in approximately 24 hours. He was asymptomatic at the time of presentation. Subsequently, the patient developed only mild bradycardia. The ECG showed sinus bradycardia with striking early repolarization, ST segment elevation, and peaked T waves. These ECG abnormalities represent an unusual pattern for beta-adrenergic blocking agent toxicity.