急性下壁心肌梗死时胸导联心电图改变的临床意义

心电图V7～V9导联异常对判定后壁心肌梗死(PAMI)有重要意义.但是PAMI难于在常规12导联心电图上反映出心肌梗死的典型表现.本文探讨V1～4导联心电图改变对PAMI及右室心肌梗死(ARVI)的诊断. 1 对象和方法 1.1 对象急性下壁心肌梗死(AIMI)组:选择1995-03～2000-06住我院ccu的首发AIMI患者68(男49,女19)例,年龄30～75岁,所有病例均符合WHO规定的急性心肌梗死(AMI)诊断标准.排除左、右心室肥大;左、右束支传导阻滞;A型预激;右位心、水电解质紊乱等情况.对照组:临床除外心肺疾病的健康者84(男58,女26)例,年龄30～75岁. 1.2 方法 AIMI患者,入院时除做常规标准12导联心电图外,均加做V7～9及V3R～V5R导联.发病第1天每6 h做1次,以后每24 h做1次,3 d后每周2～3次,连续心电监护1周 .对照组做标准12导联心电图.     

常规导联及头胸导联心电图与核素显像对急性下壁心肌梗死诊断的比较

目的：观察心电图与核素显像对急性下壁心肌梗死（AIMI）定位诊断的价值。方法：以90例冠状动脉造影的资料（其中AIMI患者50例,正常人40例）为标准,与同步记录的常规导联心电图,头胸导联心电图,和核素显像检测的结果进行比较。结果：对AIMI诊断,常规导联心电图的准确率为84.4%,敏感性为86.0%,特异性为82.5%;头胸导联心电图的诊断准确率为97.8%、敏感性为96.0%,特异性为100.0%;核素显像的诊断准确率为94.4%、敏感性为92.0%,特异性为97.5%。头胸导联心电图诊断AIMI的准确率、敏感性和和特异性均明显高于常规导联心电图（P〈0.05）,且高于核素显像但差异无显著性（P〉0.05）。结论：对于急性下壁心肌梗死的定位诊断头胸导联心电图准确率、敏感性和和特异性好于常规心电图,与核素显像无显著差异,但检测方便,有推广价值。     

头胸导联心电图诊断冠心病的价值

目的 :比较 Wilson导联心电图 （常规 ECG）和头胸导联心电图 （HCECG）对冠心病的诊断价值。方法 :在 14 3例经选择性冠状动脉造影 （CAG）患者中 ,确诊的冠心病患者 12 9例 .分别使用常规心电图机和头胸导联心电图机非同步记录常规 ECG和 HCECG图形 ,由专业人员盲法分析其结果 ,评价二种方法对冠心病的诊断价值。结果 :常规 ECG诊断冠心病的灵敏度、特异度和准确度分别为 5 9% ,5 7% ,5 7%。HCECG诊断冠心病的灵敏度、特异度和准确度分别为 79% ,5 0 % ,76 %。HCECG均显著高于常规 ECG（P<0 .0 1）。结论 :HCECG对冠心病的诊断价值明显高于常规 ECG。     

常规导联心电图表现单纯正后壁心肌梗死1例

患者 ,女 ,6 5岁 ,因发作性胸部不适 6年 ,加重 1ｄ入院。其不适主要为下胸部胀闷感 ,重时伴左臂酸胀。多因活动或情绪激动诱发 ,持续 3～ 5ｍｉｎ可自行缓解或含服“消心痛”后缓解。 1ｄ来发作频繁 ,近 2 0ｈ呈持续性 ,且程度加重 ,伴恶心、呕吐 ,含服“消心痛”无效入院。体检无异常 ,心电图 :Ⅱ、Ⅲ、ａＶＦ导联Ｔ波低平 ,Ｖ1～ 4 呈Ｒｓ型、ＳＴ段压低0 .5～ 1.5ｍｍ ,Ｔ波直立 ,Ｖ5,6呈 ｑＲ型 ,ＳＴ段压低 ,Ｔ波倒置。故加作Ｖ7～ 9、Ｖ3Ｒ～ 5Ｒ 导联 ,显示Ｖ7呈ｑＲ型 ,Ｖ8,9呈ＱＲ型、ＳＴ段轻度抬高 (图 1)。急查心脏超声 :左室…     

健康青年右胸头胸导联心电图和常规导联心电图对比分析

目的 :对比观察头胸导联心电图和常规导联心电图反映右室心电活动的差异。方法 :对 5 0例健康青年进行右胸头胸导联和常规导联 2种心电图的检查 ,并对 P波、QRS波、T波进行对比。结果 :右胸头胸导联心电图 P波、R波、直立 T波较常规导联对应的各波波幅明显增大。而前者的 Q波及部分 S波波幅较后者明显减小。右胸头胸导联心电图未见宽深 Q波和倒置 T波。结论 :头胸导联心电图较常规导联心电图更好地反映右室的心电活动     

急性下壁心肌梗死心电图aVR导联ST段压低的临床意义

目的:评价急性下壁心肌梗死(MI)患者心电图aVR导联ST段压低的临床意义。方法:43例急性下壁MI患者根据有无aVR导联ST段压低分为2组,并分析其临床情况。结果:ST段压低组肌酸激酶及肌酸激酶同工酶峰值浓度明显高于非ST段压低组[(47.25±25.42)∶(25.50±15.46)mmol/L,P<0.01;(2.82±1.99)∶(1.80±0.86)mmol/L,P<0.05,ST段压低组患者并发后壁MI比例亦明显高于非ST段压低组(56%∶9%,P<0.01)。结论:急性下壁MI心电图aVR导联ST段压低提示梗死面积较大,累及下侧壁或后壁;且有助于并发后壁MI的诊断。     

头胸导联心电图对冠心病诊断价值的分层分析

目的 :分层分析比较头胸导联心电图 （头胸 ECG）和常规导联心电图 （常规 ECG）对冠心病的诊断价值。方法 :对 110例行选择性冠状动脉造影 （CAG）的疑诊冠心病患者 ,使用头胸导联心电图机和常规导联心电图机非同步记录头胸 ECG和常规 ECG图形 ,由专业人员盲法分析其结果 ,并对结果进行进一步的分层分析 ,评价二种方法对冠心病的诊断价值。结果 :头胸 ECG诊断冠心病的灵敏度、特异度和准确度分别为 72 % ,50 % ,69%。常规 ECG诊断冠心病的灵敏度、特异度和准确度分别为 45% ,43 % ,45%。头胸 ECG诊断冠心病的灵敏度、准确度均显著高于常规 ECG（均为 P<0 .0 1） ,二者诊断冠心病的特异度无显著性差异 （P>0 .0 5）。分层分析显示头胸 ECG及常规 ECG对冠心病诊断的灵敏度与冠状动脉病变的程度、范围显著相关 ,头胸 ECG对右室心肌缺血诊断优于常规 ECG。结论 :头胸 ECG诊断冠心病较常规 ECG更有价值     

头胸导联心电图诊断急性正后壁心肌梗塞的探讨

本文对23例急性正后壁心肌梗塞患者及40名正常人进行了背部导联与头胸导联心电图对照研究。结果显示正常人头胸导联QRS波幅明显高于背部导联,ST段无明显偏移。急性心肌梗塞患者头胸导联病理性Q波加深ST段抬高幅度显著大于背部导联(P<0.01)。     

急性下壁心肌梗死累及侧后壁或右心室对下壁及胸前导联ST段的影响

下壁和胸前导联 ST段改变是急性下壁心肌梗死 ( AIMI)时常见的心电图 ( ECG)表现。本文分析63例 AIMI伴 (或不伴 )侧后壁 ( LPMI)或右心室梗死 ( RMI)患者的 ECG,旨在探讨其对下壁及前壁导联 ST段的影响及其临床意义。1　对象与方法1 996年 1月～ 2 0 0 0年 1 0月 ,我院收治首次AIMI患者 63例 ,所有患者均符合 WHO的 AMI诊断标准 ,且在发病后 1 2 h内入院 ,所有患者有明确的胸痛史 ,典型的 、 、a VF导联 ST段抬高及心肌酶学动态演变。 RMI者有 2次以上 ECG示V3 R～ 5R连续≥ 2个导联 ST段抬高 >1 mm,其中V4 R导联 S…     

右室心肌梗死的心电图分析

右室心肌梗死的心电图分析辛胜军（韶关市第一人民医院心电图室５１２０００）关键词心肌梗死；心电描记术１９９０－０２至１９９４－０２，本院住院的７４例膈面心肌梗死患者中合并右室梗死者９例（男７例，女２例，年龄６１岁～９１岁），占１２％，其中同时合并正后壁...     

右室梗死的心电图诊断标准的探讨

目的 评价有关右室梗死各心电图诊断标准的准确性、特异性和实用怀。方法 根据临床常使用的诊断右室梗死的五个心电图标准对２０例急性壁心肌梗死患者的心电图及冠状动脉造影结果进行分析了比较。结果 右室梗死的发生率为４０％,梗死部位在右冠状动脉者占９０．０％,伴右室梗死时梗死发生在右冠近端者占８７．５％。五个诊断标准对右室梗死的评估显示：标准１和５较好,使用修正标准后敏感性与特异性改进不大。而２、３及４三个     

急性下壁合并右心室心肌梗死的心电图诊断价值

目的 探讨急性下壁合并右心室心肌梗死的心电图诊断价值。方法 71例急性下壁心肌梗死患者按冠状动脉造影结果分为合并右心室心肌梗死组（观察组,31例）和未合并右心室心肌梗死组（对照组,40例）,进行12导联及右胸导联心电图检查,分析STV3R～V6R抬高≥1mm、STⅢ/STⅡ抬高≥1及两项联合对急性下壁合并右心室心肌梗死的诊断价值。结果 观察组ST段抬高3项指标阳性率均明显高于对照组（P〈0.05）,其敏感性分别为90.32%、83.87%和80.65%;特异性分别为95.00%、92.50%和97.50%。两项指标联合可获较高特异性及阳性预测值。结论 心电图STV3R～V6R抬高≥1mm及/或STⅢ/STⅡ抬高≥1有助于急性下壁合并右心室心肌梗死的临床诊断。     

Regional right ventricular dysfunction in acute pulmonary embolism and right ventricular infarction.

BACKGROUND: A normally contracting right ventricular apex associated to a severe hypokinesia of the mid-free wall ('McConnell sign') has been considered a distinct echocardiographic pattern of acute pulmonary embolism. OBJECTIVE: To evaluate the clinical utility of the 'McConnell sign' in the bedside diagnostic work-up of patients presenting to the Emergency Department with an acute right ventricular dysfunction due to pulmonary embolism or right ventricular infarction. DESIGN: Among 201 patients, consecutively selected from our clinical database and diagnosed as having massive or submassive pulmonary embolism or right ventricular infarction, 161 were suitable for an echocardiographic review of regional right ventricular contraction and were included in the study. There were 107 cases with pulmonary embolism (group 1) and 54 cases with right ventricular infarction (group 2). All echocardiographic studies were randomly examined by two experienced and independent echocardiographers, blinded to the patient diagnosis and without Doppler informations. RESULTS: The McConnell sign was detected in 75 of 107 patients in group 1 (70%) and in 36 of 54 patients in group 2 (67%); the finding was absent in 32 cases in group 1 and in 18 cases in group 2 (P=0.657). The sensitivity, specificity, positive and negative predictive values of the McConnell sign for the diagnosis of pulmonary embolism were respectively 70, 33, 67 and 36%. CONCLUSIONS: In a clinical setting of patients with acute right ventricular dysfunction the McConnell sign cannot be considered a specific marker of pulmonary embolism.     

In inferior myocardial infarction,neither ST elevation in lead V1 nor ST depression in lead I are reliable findings for the diagnosis of right ventricular infarction

Objective

In the presence of inferior myocardial infarction (MI), ST depression (STD) in lead I has been claimed to be accurate for diagnosis of right ventricular (RV) MI. We sought to evaluate this claim and also whether ST Elevation (STE) in lead V1 would be helpful, with or without STD in V2.

实验性急性单纯右心室心肌梗死的心电图变化

为探讨急性单纯右心室梗死的心电图变化,对10条犬实验性闭胸式急性单纯右心室梗死模型(病理解剖证实单纯右心室心肌游离壁梗死,范围31.4％±5.5％)定时描记体表心电图。结果显示:右胸导联(V_(5R)、V_(4R)、V_(3R)V_(1R)ST段显著抬高,R波振幅降低或形成Q波,而V_5和Ⅱ、Ⅲ、aVF导联ST段呈相应程度下移;ST段变化于右冠状动脉堵闭后15min达高峰值。揭示犬右胸前导联与下壁导联存在有对应关系,为临床上右心室与下壁心肌梗死并存的心电图变化提出了可能的机制。     

Pulsed Doppler tissue imaging can help to identify patients with right ventricular infarction

This study was planned to assess whether tissue Doppler imaging is a useful method for the detection of the right ventricular myocardial infarction. Forty-eight patients with acute inferior myocardial infarction and 24 age- and sex-matched healthy controls were included in this study. Twenty-four patients had electrocardiographic signs of inferior myocardial infarction without right ventricular infarction (group I), and the other 24 patients had electrocardiographic signs of inferior myocardial infarction with right ventricular infarction (group II). From the echocardiographic apical four-chamber view, peak systolic, early diastolic, and late diastolic velocities of the tricuspid annulus at the right ventricular free wall were recorded with the use of pulsed-wave Doppler tissue imaging. The tricuspid annular peak tissue Doppler imaging systolic velocity was significantly lower in group I (14.03 ± 2.57cm/s, P 0.005) and in group II (8.50 ± 0.84cm/s, P 0.005) than in controls (16.63 ± 2.31cm/s). The tricuspid annular peak systolic (8.50 ± 0.84cm/s vs 16.63 ± 2.31cm/s) and peak early diastolic (10.99 ± 3.28cm/s vs 19.39 ± 4.3cm/s) velocities were significantly lower in group II than in group I, as compared with controls (P 0.001). Peak early diastolic velocity of tricuspid annulus (10.99 ± 3.28cm/s vs 19.39 ± 4.3cm/s) was significantly lower in group I than in controls (P 0.001); however, late diastolic velocity was significantly lower in group II (15.98 ± 5.08cm/s, P 0.05) than in group I (18.21 ± 2.63cm/s, P 0.05) and in controls (19.02 ± 5.29cm/s). The results of this study indicate that tricuspid annular peak systolic and early diastolic velocities are reduced in patients with right ventricular infarction. The velocity of the tricuspid annulus by tissue Doppler imaging is simple and can be used to distinguish whether patients with inferior myocardial infarction have right ventricular infarction.This study was presented at the XXIII. Congress of the European Society of Cardiology, Stockholm, Sweden, 1–5 September 2001     

急性下壁梗死伴或不伴右心室心肌梗死患者临床特征的比较

目的：比较急性下壁心肌梗死（IWMI）伴或不伴右心室心肌梗死（RVMI）患者的临床特征差异。方法纳入2006年10月~2012年12月总参保健处发病12 h内入院的急性下壁心肌梗死（IWMI）患者256例,根据冠状动脉造影（CAG）结果将患者分为IWMI不合并RVMI组（n=167）和IWMI合并RVMI组（n=89）,比较两组患者冠心病发病主要危险因素（包括吸烟、高血压、糖尿病、高脂血症、冠心病家族史）、临床表现、并发症和治疗用药的差异。结果两组患者冠心病主要危险因素无差异（P＞0.05）。IWMI合并RVMI患者出现低血压（80.0% vs.19.8%,P＜0.05）、颈静脉怒张（50.6%vs.1.8%）和Kussmaul征（51.7%vs.1.2%）的比例明显增加（P均＜0.01）,需要更多地应用正性肌力药物（60.7%vs.16.2%）来维持血压,且病死率较高（77.9%vs.0.6%,P＜0.05）。结论在IWMI基础上伴RVMI多合并右心功能障碍,可导致预后不良。     

急性下壁心肌梗死伴右室梗死的临床表现和预后分析

目的探讨急性下壁心肌梗死(心梗)不伴或伴右室心梗患者的临床特征、治疗和预后。方法回顾既往6年住我院的103例急性下壁心梗患者,比较下壁心梗不伴右室心梗(65例)和伴右室心梗(38例)两组患者的临床特征和院内死亡率。结果发生低血压、心源性休克、快速心律失常(阵发性心房颤动,非持续性室性心动过速)、缓慢心律失常(包括窦性心动过缓,Ⅲ度房室传导阻滞)在下壁伴右室心梗组高于下壁心梗组,两组比较有显著性差异(P<0.05)。两组左心室射血分数(LVEF)及经皮冠脉介入(PCI)治疗患者的院内病死率比较无显著差异(P>0.05)。结论血流动力学障碍和心律失常是右室心梗住院并发症高的主要因素,右室心梗是独立于左室功能损害的危险因素,早期介入治疗能改善住院死亡率。     

急性前壁心肌梗死后T波的动态变化与心肌损害和左心室功能关系

目的 :探讨急性心肌梗死 (AMI)后T波的动态变化与心肌损害和左室功能之间的关系。方法 :6 2例前壁Q波型AMI患者 ,其中T波由倒置转为直立 ,即T波正常化 39例 (<3个月 6例 ,>3～ 6个月 14例 ,6～12个月 19例 ) ;T波持续直立 5例 ;T波持续倒置 18例。AMI后常规记录 12导联心电图。采用二维超声心动图、彩色心室壁动力分析和超声学定量 (AQ)技术检测室壁运动和左心室收缩功能状况。结果 :T波持续倒置组血浆肌酸激酶 (CK)峰值和心室壁运动得分指数 (WMSI)明显高于T波直立组 ,而左心室短轴缩短率 (FS)、峰值排空率 (PER)和射血分数 (EF)显著低于T波持续直立组 ;且T波正常化越早左心功能恢复得越好。T波持续直立组血浆CK峰值、WMSI均高于T波直立各亚组和T波持续倒置组 ,而FS、EF和PER均显著低于各亚组。结论 :AMI后 12个月异常Q波导联的T波动态变化能用于评价左心室的局部和整体收缩功能     

Primary angioplasty for infarction due to isolated right ventricular artery occlusion

We report an unusual case of an isolated right ventricular infarction with haemodynamic compromise caused by spontaneous isolated proximal occlusion of the right ventricular branch of the right coronary artery(RCA), successfully treated by balloon angioplasty. A 58-yearold gentleman presented with epigastric pain radiating into both arms. Electrocardiograph with right ventricular leads confirmed ST elevation in V4 R and a diagnosis of isolated right ventricular infarction was made. Urgent primary percutaneous intervention was performed which revealed occlusion of the right ventricular branch of the RCA. During the procedure, the patient’s blood pressure dropped to 80/40 mm Hg, and echocardiography showed impaired right ventricular systolic function. Despite aggressive fluid resuscitation, the patient remained hypotensive, continued to have chest pain and persistent electrocardiograph changes, and hence balloon angioplasty was performed on the proximal right ventricular branch which restored flow to the vessel and revealed a severe ostial stenosis. This was treated with further balloon angioplasty which restored TIMI 3 flow with resolution of patient’s symptoms. Repeat echocardiography showed complete resolution of theST-elevation in leads V4 R and V5 R and partial resolution in V1. Subsequent dobutamine-stress echocardiography at 4 wk showed good left and right ventricular contractions. The patient was discharged after a 3-d inpatient stay without any complications.