右前额的电位值—与头胸导联商榷

本文对41例正常人的 aVR 导联和右前额部位的单极加压导联心电图进行对比分析。结果右前额体表面电位值近乎 VR 导联,不是“0”是负值。并以此与头胸导联讨论了关于单极性、P、R、T 正相波阵及电谷状 S 波阵等问题。说明头胸导联的设计依据偏高了客观实际,它实质是一种参比量为负值的双极导联。     

Nehb导联与常规导联心电图P波对比分析

目的 对比观察Nehb导联和常规导联心电图P波的差异。方法 对80例健康体检人员进行Nehb导联和常规导联两种心电图检查,对P波的振幅、时限进行对比。结果Nehb导联心电图D、A导联较常规导联心电图Ⅰ、Ⅱ、aVF导联各P波振幅明显增高,有显著性差异,（P〈0.05）。两种导联P波时限比较无显著性差异,P〉0.05。结论Nehb导联较常规导联心电图P波显示清楚。     

S5导联与常规导联心电图P波对比分析

目的探讨S5导联P波的临床意义.方法描记108例青年人常规肢导联和S5导联心电图,比较分析肢导联P波与S5导联P波的大小及与平均心电轴的关系.结果 S5导联P波大于肢导联P波29例(26.9%)、小于肢导联P波45例(41.7%),两组的平均心电轴差异无统计学意义.结论 在青年人中S5导联P波比常规肢导联P波清晰者只占少数.     

右心结构改变与心电图V1导联P波终末电势的关系

目的:应用超声心动图检查,分析右心结构改变与心电图上V1导联P波终末电势(ptfV1)的关系.方法:对52例同时行心电图及超声心动图检查的病例进行分析.结果:右心房心尖四腔短径、右心室心尖四腔长径ptfV1值即P波直立组、ptfV1＞-0.03 mm·s组、ptfV1≤-0.03 mm·s组三个组间比较,差异有统计学意义(P＝0.001,表2);但各组间LSD法检测P波直立组与ptfV1＞-0.03 mm·s组之间比较差异无统计学意义(P＞0.05).右心室短轴流出道内径ptfV1值即P波直立组、ptfV1≤-0.03 mm·s组、ptfV1＞-0.03 mm·s组三个组间比较,差异有统计学意义(P<0.05);但各组间LSD法检测P波直立组与ptfV1＞-0.03 mm·s组比较,差异无统计学意义(P＞0.05).肺动脉主干内径、右心房心尖四腔长径、左心室长轴观右心室前后径及右心室心尖四腔短径在P波直立组、ptfV1≤-0.03 mm·s组、ptfV1＞-0.03 mm·s组三个组间比较差异均无统计学意义(P＞0.05);各组间LSD法检测差异均无统计学意义(P＞0.05).结论:心电图ptfV1的出现与右心结构变化有一定关系.     

P波分析

由于左、右心房传导的顺序及窦房结与房室结之间存在结间束 ,因此 ,P波的改变常系多种因素作用的结果。1　二尖瓣型 P波心电图特征及病因　心电图特征为 :1PV1 负向波 >0 .0 4s,深度 >- 0 .4m V,Ptfv1 绝对值 >-0 .4m m· s;2 P 呈现双峰 ,峰距≥ 0 .0 4s,时限≥ 0 .12 s;3P波宽度与 P- R段比值 >1.6。引起原因为 :1风心病 ,2心肌梗死 ,3心房梗死 ,4高血压病 ,5严重的支气管或肺气肿 ,6间歇性、不全性房间束阻滞 ,7P波电交替 ,8房性心律失常 ,9非典型预激综合征。2　肺型 P波心电图特征及病因　心电图特征为 :1P波时限正常 ;2形态高耸…     

HC导联QRS波心电轴测试方法探讨

Wilson' s导联 (常规导联 ) QRS波心电轴测量与应用对诊断心脏左右心室肥大、束支传导阻滞等提供了有价值的诊断依据。头胸导联 ( HC)导联作为一种新型的导联系统 ,没有一种完整系统的心轴测试方法。我们根据尹炳生提出的拟球状面波陈传递假说利用 HC导联系统的 HL3,HR3导联测试 HC导联系统 QRS波心电轴 ,并以此探讨 HC导联心电轴测试方法。对象与方法随机选择我院门诊与住院患者 5 9例 ,年龄 19～ 81岁。平均年龄 4 3 .3岁 ,采用日本 65 11单导心电图机在同一部位作同步记录常规导联与 HC导联心电图。纸速 2 5 mm/ s,定标电压 10m…     

单导联和同步12导联测量对P波时限的影响

目的 探讨单导联和同步12导联两种测量方式对P波时限的影响.方法 选取经心脏超声检查无结构和功能异常且无明确临床疾病诊断的健康成年人,分别测量单导联和同步12导联心电图的P波时限,对比两种测量方式的P波时限.结果 共入选203例受试者,平均年龄(39.51±10.08)岁.同步12导联测得的P波时限[109(102,1...     

上腹导联诊断右心室梗塞价值的探讨

用上腹三个导联MR、ME、ML对正常组,普通心梗组,右室梗塞组对比观察,并经统计学分析,结果显示MR导联在右室梗塞组阳性预测值86％,敏感性97.2％,特异性84.2％,其中尤以敏感性高,因此认为该导联可用作判定右室梗塞的重要导联之一。     

老年人持续性心前导联巨T倒置11例报告

本文报道１组老年人（８０．８±６．１岁）心前导联巨Ｔ倒置达数年之久，其特点认为酶学检查不增高，持续性心前导联Ｔ波非对称性倒置≥１．０ｍＶ，静滴硝酸甘油不改善，心绞痛发作时Ｔ波变浅。此组１１例均为冠心病，其中８例同时有高血压病，５例有心室肥厚。对于此类病人应慎下急性心内膜下心梗的诊断，慎用抗凝甚至溶栓治疗。     

70岁以上健康老年人右胸及后壁导联心电图特点分析

目的研究70岁以上健康老年人右胸及后壁导联心电图特点。方法对212例70岁以上健康老年人右胸及后壁导联的P波、QRS波及ST段进行形态观察及测量分析。结果(1)右胸导联rS波形检出率为31.1%～58.1%;QS波形检出率为14.0%～23.3%;V4R导联(QS波除外)、V5R导联各波振幅低于V3R导联(P<0.05);(2)后壁V7～V9导联qR波形检出率为50.0%～87.7%;R波形检出率为7.1%～34.9%;与V7导联比较,V8、V9导联qR波形的出现率递增,R波形出现率及R波振幅均呈现递减(P<0.05);(3)ST段:V3R～V5R导联97.5%～98.9%位于等电位线;V7～V9导联97.2%～98.5%位于等电位线;极少数抬高者幅度<0.05mV,无ST段下降;(4)T波:V3R～V5R导联61.3%～79.2%为平坦,21.8%～25.8%为倒置;V7～V9导联45.1%～78.5%为平坦,20.0%～53.7%为直立。结论建立70岁以上老年人右胸及后壁导联心电图的诊断标准具有实际的临床意义。     

Clinical characteristics of patients with spontaneous or inducible ventricular fibrillation without apparent heart disease presenting with J wave and ST segment elevation in inferior leads

INTRODUCTION: The clinical characteristics of three patients with spontaneous or inducible ventricular fibrillation (VF) without apparent heart disease, who presented with J wave and ST segment elevation in inferior leads, are described. METHODS AND RESULTS: All patients were male and experienced syncope. Their symptoms occurred at night or early in the morning. Holter ECG revealed infrequent premature ventricular complexes. Injection with disopyramide 2 mg/kg augmented ST segment elevation. CONCLUSION: These characteristics were very similar to those of patients with Brugada syndrome. These three patients with these specific features might have a variant of Brugada syndrome.     

动态监测胸导联R波递增不良的临床意义

目的明确胸导联R波递增不良心电图患者动态心电图观察在诊断心肌梗死过程中的临床价值。方法 25例心电图表现为胸导联R波递增不良患者分为A组心肌梗死组(12例)和B组非心肌梗死组(13例),所有患者通过24小时内动态心电图观察,结合病史、其他检查检验及住院资料进行临床回顾性分析。结果心肌梗死组12(A组)例患者中有7例(58.33%),13例非心肌梗死组(B组)中1例24小时内有心电图动态变化(7.69%)。两组患者在24小时内心电图动态变化发生率上存在统计学差异(p0.01)。结论胸导联R波递增不良心电图患者进行动态心电图观察有助明确心肌梗死的诊断,在临床上发现胸导联R波递增不良心电图患者应注意动态观察,并结合病史体征和其他方法加以确诊,避免漏诊。     

Demonstration of electrical and anatomic connections between Marshall bundles and left atrium in dogs: implications on the generation of P waves on surface electrocardiogram

INTRODUCTION: The muscle bundles within the ligament of Marshall (LOM) are electrically active. The importance of these muscle bundles (Marshall bundle [MB]) to atrial activation and the generation of the ECG P wave is unclear. METHODS AND RESULTS: We used optical mapping techniques to study epicardial activation patterns in isolated perfused left atrium in four dogs. In another seven dogs, P waves were studied before and after in vivo radiofrequency (RF) ablation of the connection between coronary sinus (CS) and the LOM. Computerized mapping was performed before and after RF ablation. Optical mapping studies showed that CS pacing resulted in broad wavefronts propagating from the middle and distal LOM directly to the adjacent left atrium (LA). Serial sections showed direct connection between MB and LA near the orifice of the left superior pulmonary vein in two dogs. In vivo studies showed that MB potentials were recorded in three dogs. After ablation, the duration of P waves remained unchanged. In the other four dogs, MB potentials were not recorded. Computerized mapping showed that LA wavefronts propagated to the MB region via LA-MB connection and then excited the CS. After ablation, the activation of CS muscle sleeves is delayed, and P wave duration increased from 65.3 +/- 14.9 msec to 70.5 +/- 17.2 msec (P = 0.025). CONCLUSION: In about half of the normal dogs, MB provides an electrical conduit between LA free wall and CS. Severing MB alters the atrial activation and lengthens the P wave. MB contributes to generation of the P wave on surface ECG.     

非体外循环冠状动脉旁路移植术后一过性J波伴T波高耸的观察与分析

目的 探讨非体外循环冠状动脉旁路移植术(OPCAB)后形成一过性J波伴T波高耸的相关因素及其意义.方法 回顾性分析55例行OPCAB患者的临床资料,根据心电图是否出现J波伴T波高耸,分为有一过性J波伴T波高耸组(观察组18例)与无一过性J波伴T波高耸组(对照组37例),比较两组冠状动脉病变受累情况、冠状动脉狭窄的程度、...     

Dispersion of P wave duration and P wave vector in patients with atrial septal aneurysm.

AIMS: Atrial septal aneurysm (ASA) may be involved in the genesis of atrial arrhythmias as a consequence of disturbances in the propagation of depolarization, which may be easily assessed by P wave dispersion measurement. The aim of this study is to assess the dispersion of P wave duration and P wave vector in patients with ASA and to determine the effect of associated interatrial shunt on the magnitude of P wave dispersion. METHODS AND RESULTS: The study population consisted of 23 healthy volunteers and 88 patients with ASA base more than 15 mm and protrusion more than 7.5 mm. The size of aneurysms and atria was determined by echocardiography and P wave dispersion was measured on the surface ECG. In ASA patients, dispersion of P wave duration was significantly increased when compared with healthy controls (7.8 +/- 12.1 vs. 3.7 +/- 3.5 ms; P < 0.01). Dispersion of P wave vector was also significantly increased (8.5 +/- 10.1 degrees vs. 4.6 +/- 3.6 degrees ; P < 0.005). In healthy volunteers, the mean values of both parameters were below the cutoff points. CONCLUSION: In patients with ASA, there was a significant dispersion of P wave duration and P wave vector. Variation in P wave duration was significantly correlated with the dispersion of P wave vector and age of these patients. Dispersion of P wave vector was significantly decreased in ASA patients with interatrial shunt. P wave dispersion in ASA patients may predispose to the development of atrial arrhythmias.