室性期前收缩揭示急性心肌梗死合并完全性右束支传导阻滞

1 病例报告 患者,男,54岁,因胸骨后疼痛2小时伴气急、出汗来院就诊,BP 135/90mmHg,心率86次/分,心电图见频发室性早搏二联律,V1导联室性早搏呈QR型,V2、V3、Ⅱ导联呈QS型,Ⅱ、Ⅲ、aVF、V1～5ST段导联抬高0.1～0.5mV,Ⅱ、Ⅲ、aVF导联ST段弓背向上,胸导联T波异常高耸,V3达2.2mV,肢体导联QRS电压低下.室性早搏波形显现急性下壁、前壁心肌梗死图形(见图1).收住院后查心电图见Ⅱ、Ⅲ、aVF、V1～5导联异常Q波和QS型,V1导联呈qR型,Ⅰ、Ⅱ、aVR、aVL、V5、V6导联QRS终末波粗钝,其中Ⅱ、V1～3导联图形与图1室性早搏图形相似(见图2).血心肌酶谱升高,诊断为急性下壁、前壁心肌梗死,完全性右束支传导阻滞.经过治疗,患者病情好转.查心电图见完全性右束支传导阻滞消失,Ⅱ、Ⅲ、aVF、V1～4导联呈QS型.T波振幅下降,ST段尚未明显回降(见图3),数周后患者自感良好,要求出院,继续门诊随访.     

心电图在急性肺动脉栓塞诊断中的价值

目的 评估心电图对急性肺动脉栓塞(肺栓塞)的诊断价值.方法 回顾性分析43例既往无心肺疾病的急性肺栓塞患者住院首次、溶栓后及出院前系列心电图变化.结果 ①入院时首次心电图:心动过速26例(60.47%),右束支传导阻滞10例(23.26%);V1导联和V1～V2导联、V1～V3导联、V1～V4导联、V1～V5导联、V1～v6导联T波倒置分别为34例(79.70%)、20例(46.52%)、12例(27.91%)、9例(20.93%)、7例(16.28%)和2例(4.65%);SⅠ＞0.1 mV、TⅢ倒置、QⅢ和SⅠQⅢTⅢ分别为23例(53.49%)、21例(48.84%)、27例(62.79%)和20例(46.52%).②溶栓后心电图:心动过速消失20例(76.9%),右束支传导阻滞消失4例(40%),胸前导联T波倒置加深4例,SⅠ变浅、QⅢ减小或消失、TⅢ倒置变浅或直立11例.③出院前心电图:心动过速消失;胸前导联T波直立数增加,ST段回基线,QⅢ进一步减小或消失,TⅢ倒置变浅或直立.结论 急性肺栓塞心电图变化多变,需动态观察并密切结合临床加以识别.     

心电图在急性肺动脉栓塞和急性非ST段抬高型心肌梗死鉴别诊断中应用

目的探讨心电图在急性肺动脉栓塞(APE)与急性非ST段抬高型心肌梗死(NSTEMI)鉴别诊断中应用价值。方法选择2008年—2013年我院收治的APE患者45例为APE组,NSTEMI患者85例为NSTEMI组,于入院6h内行标准12导联心电图检查,分析比较两组患者心电图变化的差异。结果 (1)APE组V1-V3导联ST段压低、V1-V3导联T波倒置发生率为51.11%、46.67%,高于NSTEMI组的20.00%、23.53%,差异有统计学意义(P0.05),NSTEMI组V4-V6导联T波倒置并ST段压低发生率为30.59%,显著高于APE组的15.56%,两组比较差异有统计学意义(P0.05)。(2)Logistic回归分析证实,V1-V3导联ST段压低及其T波倒置是APE的重要预测因子;V4-V6导联T波倒置并ST段压低是APE和NSTEMI的重要预测因子。(3)APE低、中、高风险患者间比较,SⅠQⅡTⅢ症差异有统计学意义(P0.05)。结论 V1-V3导联ST段压低与Ⅱ、Ⅲ、aVF及V1-V3导联T波倒置需高度怀疑APE的可能,而V4-V6导联T波倒置、V4-V6导联T波倒置并ST段压低发生NSTEMI的可能性较高。     

血管迷走性晕厥儿童在直立倾斜试验中同步十二导联心电图P波ST段及T波的动态变化

目的 探讨血管迷走性晕厥(WS)儿童直立倾斜试验(HUTT)中自主神经功能变化,深化儿童VVS的发病机制.方法选择2006-10～2007-10在中南大学湘雅二医院儿童晕厥专科门诊就诊或住院的不明原因晕厥(UPS)儿童96例,根据HUTT结果将研究组分为HUTT阳性组和HUTT阴性组.选取年龄、性别匹配的健康儿童28例作为对照组.研究组和对照组均行HUTF检查,HUTT过程中同时行12导联心电图(12 ECG)动态监测.结果①57例HUTT阳性儿童中,13例表现为基础直立倾斜试验(BHUT)阳性,平均反应时间(24.62±5.94)min;44例表现为舌下含化硝酸甘油倾斜试验(SNHUT)阳性,平均反应时间(5.27±1.89)min.②SNHUT阶段1 min时HUTT阳性组Ⅲ、aVL、aVF导联P波振幅较HUTT阴性组显著升高(P<0.05),其余时间段两组比较差异无统计学意义(P>0.05).③研究组在HUTT中某些导联T波及ST段振幅较对照组显著降低(P<0.05),主要表现在V3、V4、V5及V6导联;HUTT阳性组在HUTT中某些导联T波、ST段振幅较HUTT阴性组显著降低(P<0.05),主要表现在Ⅱ、Ⅲ、aVR、aVL及aVF导联,多发生在HUTF阳性发作平均时间点.④HUTY阳性组晕厥发作时较基础平卧位时P波时间、QRS时间、QT间期显著缩短(P<0.05,P<0.01);与倾斜开始比较,P波时间显著缩短(P<0.05);与倾斜5 min时比较,各指标无显著变化(P>0.05);与试验结束电动倾斜床刚平放时比较,QT间期显著缩短(P<0.01),而QTc间期显著延长(P<0.05).结论VVS儿童存在心脏自主神经功能改变,12 ECG T波及ST段振幅变化较P波振幅变化更敏感.     

肥厚型心肌病心电图特点与超声心动图临床分析

目的：探讨肥厚型心肌病心电图特点与超声心动图的关系，提高临床对该病的诊断意识。方法：对23例确诊为肥厚型心肌病的临床资料进行分析。结果：所有肥厚型心肌病病人的心电图均有ST-T的异常表现，8例间隔肥厚型心肌病表现为Ⅱ、Ⅲ、aVF病理性Q波及ST段抬高；6例心尖肥厚型心肌病表现为Ⅰ、aVL、V2-V6导联巨大倒置T波；9例普遍肥厚型心肌病表现为V4-V6、导联T波倒置或伴有Ⅱ、Ⅲ、aVF导联T波倒置，其改变范围小。结论：重视心电图的改变特点并与心脏超声相结合可以提高该病的诊断符合率。     

高血压特发性肥厚性主动脉下狭窄18例心电图分析

目的 :探讨高血压特发性肥厚性主动脉下狭窄 (IHSS)心电图特征。方法 :回顾性分析 1986～ 2 0 0 0年收治的 18例高血压IHSS患者的资料。结果 :心电图显示V1,aVR导联T波直立 ;Ⅰ ,Ⅱ ,Ⅲ ,aVL ,aVF ,V3 ～V6导联T波倒置 0 4～ 1 0mV。 8例ST段呈凸面下移 0 0 5～ 0 2mV。 14例胸导联V3 ～V6R波之和 >6 5mV ,8例有Q波 (多见Ⅱ ,Ⅲ ,aVF ,aVL导联 ) ,仅 3例有室性早搏。结论 :V1,aVRT波直立 ,V3 ～V6T波深倒置及R波之和 >6 5mV ,对高血压IHSS临床初诊及筛选具有一定实用价值。     

飞行员平板运动试验恢复期ST段压低特点和原因分析

目的探讨平板运动试验恢复期出现ST段压低的特点和原因。方法分析17例飞行员平板运动试验恢复期ST段压低的形态、持续时间以及同导联P波振幅、P-R段和体检鉴定资料,并与同期102例飞行员运动试验阴性者比较。结果恢复期ST段压低者以Ⅱ、Ⅲ、aVF导联多见,占82.4%(14/17);ST段压低在0.10～0.22 mV,平均(0.15±0.04)mV,ST段压低以Ⅲ导联最为显著;ST段压低持续时间2～5 min,平均(3.6±1.0)min,多在4 min内恢复正常,占76.5%(13/17);ST段多呈J点型压低,占82.4%(14/17),其中15例(88.2%)伴P-R段下斜型压低;恢复期ST段压低者,P波振幅在运动终点、运动后3 min以及运动后6 min均明显高于对照组(P＜0.01)。结论运动试验恢复期出现短暂性J点型ST段压低可能与心房复极向量增大有关,应注意结合同导联P波振幅和P-R段形态与病理性ST改变鉴别。     

aVR导联QRS波形态对下壁心肌梗死的鉴别诊断意义

目的 探讨aVR导联QRS波形态对下壁心肌梗死的鉴别诊断意义.方法 分析52例Ⅲ、aVF导联均为病理性Q波患者的aVR导联QRS波形态,并与选择性冠状动脉造影结果对照.结果 aVR导联QRS波呈rS(s)型、QS(qs)型和Q(q)r型的患者分别为13例、10例和29例,三种形态与冠状动脉造影结果比较显示右冠状动脉或左回旋支有狭窄、闭塞病变的患者分别为12例、4例和0例,差异有统计学意义(χ2=35.56,P=0.000).结论 aVR导联QRS波形态对Ⅲ、aVF导联均为病理性Q波患者具有鉴别诊断意义.aVR导联QRS波呈Q(q)r型,可排除陈旧性下壁心肌梗死;aVR导联QRS波呈rS(s)型,可基本确定有陈旧性下壁心肌梗死.     

心电图在肺栓塞诊断中的应用价值

目的:探讨心电图对肺栓塞(PE)的诊断价值.方法:分析2001年9月～2006年12月我院确诊的94例PE心电图的变化特征.结果:心电图提示窦性心动过速53例(56.4%),SⅠQⅢTⅢ征24例(25.5%),单纯SⅠ40例(42.6%),QⅢ49例(52.1%),TⅢ46例(48.9%),aVR主波向上13例(13.8%).Ⅱ、Ⅲ、aVF及胸前导联T渡变化及ST-T异常在PE中也较常见,共60例(63.8%);完全性或不完全性右束支传导阻滞7例(7.4%),右心室肥大37例(39.4%).10例溶栓治疗成功后心电图即刻恢复正常.结论:PE心电图变化具有一过性、多变性的特点,并随病程发展而呈动态变化,对诊断PE有重要价值.     

肥厚型心肌病心电图长期随访对比分析一例

患者男,42岁,十余年前自述平时无任何不适,偶然体检时做心电图检查发现异常。心电图(图1)示:Ⅰ、V3～V6导联均呈rS波,aVL呈Qr波,Ⅱ、Ⅲ、aVF呈Rs波,V1、V2导联呈高R波;QRS波时限0.08s;电轴右偏+120°;Rv1+Sv5=2.8mV、RaVR>0.5mV,R/SV5<1;V1VAT=0.04s。ST段V1、V2凹形上抬,T波Ⅱ、Ⅲ、aVF、V3导联倒置、V1、V2正负双向,余直立。     

Electrocardiographic algorithms for predicting the complexity of coronary artery lesions in ST-segment elevation myocardial infarction in ED

Objective

In reperfusion strategy for ST-elevation myocardial infarction (STEMI), emergency surgical bypass grafting might be considered for patients with significant multivessel coronary diseases complicated by cardiogenic shock. The culprit lesions in STEMI can be predicted from electrocardiographic (ECG) findings. However, whether the complexity of coronary artery lesions in STEMI can be predicted from characteristic ECG findings remained unclear.

Materials and Methods

The initial 12-lead ECG parameters in each lead recording from patients with STEMI receiving primary percutaneous coronary intervention within 12 hours were retrospectively analyzed. A sequential ECG algorithm was developed to predict the complexity of coronary artery lesions.

Results

In patients with inferior wall STEMI, the presence of the following 2-step criteria indicated 3-vessel disease (3VD), with a sensitivity of 92.1% and a specificity of 81.8%: (1) ST depression or flat T wave in leads V₅ or V₆; and (2) ST elevation of more than 2 mm in at least 1 of II, III, aVF, or Q (loss of septal r) without ST elevation in aVR. In patients with anterior wall STEMI, the following criteria indicated 3VD: (1) ST elevation of more than 4 mm in at least 1 of the precordial leads and combined with QRS interval of more than 120 ms; then (2) a flat T wave over aVR, or aVL combined with flat T wave ST depression over lead I or Q wave over all leads II, III, and aVF. This algorithm detects patients with 3VD with a sensitivity of 76.5% and a specificity of 100%. However, when the whole algorithm is completed, the sensitivity can reach up to 88.4% and the specificity can still be 100%.

Conclusion

By using this ECG algorithm, 3VD might be distinguished early from single-vessel disease in patients with STEMI for appropriate reperfusion strategy.     

Electrocardiographic Identification of Mid-Septal Accessory Pathways in Close Proximity to the Atrioventricular Conduction System

In order to identify ECG characteristics of overt midseptal accessory pathways (APs) predictive of close proximity to the AV conduction system we analyzed data from patients who underwent successful RF catheter ablation of a mid-septal AP, Mean patient age was 31 ± 16 years, and 13 were male. The 40° right anterior oblique view was used to divide the mid-septal area into 3 zones: 1 (anteriorportion); 2 (intermediate); and 3 (posterior portion). The 12-lead ECG was analyzed with regard to delta wave polarity and R/S transition in the precordial leads. The findings from patients ablated at zone 3 were compared to those at zones 1 and 2. All patients had a positive delta wave in the leads I, II, aVL, and negative delta wave in the leads III and aVR. The R/S transition occurred in lead V₂ in 80% of patients. The delta wave in lead aVF was the only ECG characteristic that correlated with the AP ablation zone. Six of 8 patients ablated at zone 3 had a negative delta wave in lead aVF while 6 out of 7 patients ablated at zone 1 or 2 had a positive or isoelectric delta wave in lead aVF (P = 0.03). A positive or isoelectric delta wave in lead aVF identifies mid-septal AP in close proximity to the AV conduction system.     

陈旧右心室梗塞期的右胸心电图研究

目的　　探索陈旧左室下壁、右室梗塞患者右胸心电图特征及临床应用价值。方法　　描记３４例临床确诊患者同时间、同部位的Ｗｉｌｓｏｎ导联（Ｖ３Ｒ－７Ｒ）和头胸（ＨＣ）导联（ＨＶ３Ｒ～７Ｒ）图形。结果　　两种方法图形大致相仿、５３％及５９％的患者分别在Ｖ３Ｒ～７Ｒ和ＨＶ３Ｒ～７Ｒ导联均含病理Ｑ波、多数Ｔ波倒置或平坦，ＳＴ段基本无编移。约 ３５％和 １６％的患者分别在 Ｖ３Ｒ、 Ｖ４Ｒ和ＨＶ３Ｒ、ＨＶ４Ｒ出现 ｒ波。 ３４例患者 ＨＶ６Ｒ、ＨＶ７Ｒ病理 Ｑ波出现率达９７％，Ｔ波倒置或平坦达８０％。２４例（７１％）患者ＨＶ６Ｒ、ＨＶ７Ｒ的 ＱＲＳ—Ｔ波群形态酷似下壁导联 ａＶＦ。结论 ＨＣ导联的ＨＶ６Ｒ、ＨＶ７Ｒ病理Ｑ波有希望提供陈旧右室梗塞的线索。     

ECG criteria for localizing the pulmonary vein origin of spontaneous atrial premature complexes: validation using intracardiac recordings

We have shown that pacemapping from each of the pulmonary veins reveals unique surface ECG characteristics. However, application of these criteria to spontaneous atrial premature complexes is often difficult because of obscuration by the prior T wave. We hypothesized that the pulmonary vein of origin of spontaneous atrial premature complexes can be determined by measuring characteristics of the P wave whether or not the P wave was superimposed on the prior T wave. We analyzed 58 spontaneous atrial premature complexes of known pulmonary vein origin in 30 patients referred for atrial fibrillation ablation. The origin of all the atrial premature complexes was documented by detailed, intracardiac multipolar catheter mapping. Based on previous work, the criteria for distinguishing right-sided from left-sided pulmonary vein origin of atrial premature complex includes: (1) P wave duration < 120 ms; (2) P wave amplitude in lead I > 0.05 mV; and (3) P wave amplitude in leads II/III > 1.25. The criteria to separate superior from inferior pulmonary veins included the sum of the P wave amplitude in all the inferior leads greater than 0.3 mV. The combination of the P wave duration < 120 ms and the ratio of the P wave amplitude in leads II/III > 1.25, distinguished right-sided from left-sided pulmonary vein origin of spontaneous atrial premature complexes with a sensitivity of 82% and specificity of 100%. The sum of the P wave amplitude in leads II, III, and aVF > 0.3 mV distinguished superior from inferior pulmonary vein of origin with a sensitivity of 39% and specificity of 73%. The pulmonary vein origin of spontaneous atrial premature complexes can often be localized using careful quantitative analysis of the surface ECG despite superimposition of the P wave upon the T wave. Separation of right-sided from left-sided pulmonary vein origin of spontaneous atrial premature complexes can be determined with good specificity and sensitivity, while the ability to distinguish inferior from superior pulmonary vein origin is limited.     

aVF导联低电压预测冠状动脉多支病变的价值

目的 探讨aVF导联低电压对预测冠状动脉多支病变的价值。方法 回顾性分析225例冠心病患者的心电图与冠状动脉造影资料，选取aVF导联低电压作为观测指标。结果 aVF导联低电压对不同冠状动脉病变范围有一定的鉴别价值。多支病变时阳性率明显增高，在排除影响因素前后分别为54．41％和56．60％，束支传导阻滞、心室肥大等对指标的判断影响不大，其预测的敏感性、特异性和准确性在排除影响因素前后分别为54．41％、68．15％、64．00％和56．60％、69．78％、66．15％。结论 aVF导联低电压对预测冠状动脉多支病变具有一定价值。     

Electrocardiographic appearance of old myocardial infarction in paced patients

This study evaluated the possibility of diagnosing chronic myocardial infarction in the presence of the pacing electrocardiogram. Forty-five patients with known myocardial infarction (anterior 23, inferior 22) and 26 healthy controls were studied. After coronary angiography, pacing was applied from the right ventricular apex, and the sensitivity, specificity, and average diagnostic accuracy of five criteria on the paced electrocardiogram were assessed: (1) Notching 0.04 second in duration in the ascending limb of the S wave of leads V3, V4, or V5 (Cabrera's sign); (2) Notching of the upstroke of the R wave in leads I, aVL, or V6 (Chapman's sign); (3) Q waves > 0.03 second in duration in leads I, aVL, or V6; (4) Notching of the first 0.04 second of the QRS complex in leads II, III, and aVF; (5) Q wave > 0.03 second in duration in leads II, III, and aVF. The most sensitive criteria, for anterior and inferior myocardial infarctions were Cabrera's and Chapman's (91.1 and 86.6%, respectively). All criteria had low specificity (range 42.3-69.2%). The combination of Cabrera's and Chapman's sign decreased the sensitivity to 77.7%, but increased specificity to 82.2%. The sensitivity and specificity of all the criteria were independent of the myocardial infarction site. In paced patients, the application of electrocardiographic criteria, and especially the combination of Cabrera and Chapman, provides useful clinical information in recognizing prior myocardial infarction but not in assigning the specific infarct site.     

New Electrocardiographic Changes in Patients Diagnosed with Pulmonary Embolism

Background

The electronic medical record is a relatively new technology that allows quick review of patients' previous medical records, including previous electrocardiograms (ECGs). Previous studies have evaluated ECG patterns predictive of pulmonary embolism (PE) at the time of PE diagnosis, though none have examined ECG changes in these patients when compared with their previous ECGs.

Cornell电压指数鉴别特勤人员左室高电压价值

目的探讨Cornell电压指数鉴别特勤人员左室高电压价值,为其心血管功能专项医学鉴定提供参考依据。方法采用12导联同步心电图仪记录年度疗养男性特勤人员常规心电图,分析2 931例QRS波电压正常者及142例左室高电压者Cornell电压指数（RaVL＋SV3电压代数和）和Sokolow电压指数（SV1＋RV5代数和）变化情况。结果健康特勤人员左室高电压主要表现在左胸导联R波电压显著性增高,其中RV5电压在2.55～2.65 mV者占12.68%（18/142）、2.70～2.95 mV者占65.49%（93/142）、3.00～3.45 mV者占16.90%（24/142）、3.50～3.95 mV者占4.23%（6/142）、4.10 mV占0.70%（1/142）,而右胸导联S波振幅和aVL导联R波振幅与正常组比较差异无统计学意义（P〉0.05）。左室高电压组Cornell电压指数〉2.8 mV仅占1.41%（2/142）,而Sokolow电压指数〉4.0 mV者高达30.28%（43/142）。结论 Cornell电压指数可作为特勤人员左室高电压与左室肥大的鉴别指标,具有方法简单、诊断准确性高的特点。     

Transition to home care after stroke: depression, physical health, and adaptive processes in support persons.

A longitudinal design was used to examine adaptation in primary support persons (PSP) of stroke survivors during the transition from hospitalization (T1) to home care (T2). The major purposes of the study were (a) to examine changes in depression, physical health, and contextual and coping factors from hospitalization of the stroke survivor through the first 6-10 weeks of home care; and (b) to identify predictors of depression. Data (N = 136) were collected on depression, physical health, background, survivor illness, and social environmental variables; appraisal of impact; social support resources; and coping skills. Reduction in mean PSP depression was significant at T2, but the change in physical health was not significant. Significant changes occurred in survivor function, family functioning, and three of six coping skills. Hierarchical multiple regression analyses were used to predict depression. T1 variables accounted for 29% of the variance in T1 PSP depression, with gender and appraisal of impact the strongest of seven predictors. T1 depression, T2 health, family functioning, and avoidance coping were the strongest of seven predictors, explaining 50% of the variance in T2 depression. Findings highlight the importance of maintaining caregiver health and preventing depression and identify variables to target for the reduction of PSP depression.