急性前壁心肌梗死合并下壁导联ST段下移的临床意义

48例首次急性前壁心肌梗死患者中伴下壁导联ST段平均下移>1mm、持续时间>48h者,CK和CK-MB的平均峰值更高,核素检查左室射血分数<40％,左室下壁运动障碍、出现放射性稀疏或缺损区的发生率也更高(P<0.05或<0.01)。说明这类病人有下壁心肌缺血,且可能心肌坏死面积更广。     

急性前壁心肌梗塞时下壁导联心电图ST段变化的意义

探讨ＥＣＧ胸前导联ＳＴ段抬高伴下壁Ⅱ，Ⅲ，ａＶＦ导联ＳＴ段压低与冠状动脉病变的关系。对６０例急性前壁心肌梗塞病例进行回顾分析，所有病人于发病后４周左右行冠状动脉造影检查。结果（１）３３例前降支单支血管病狭窄达９０％－１００％组，７７．８％出现Ⅱ，Ⅲ，ａＶＦ导联ＳＴ段压低０．１≥ｍＶ，狭窄７０％８９％组仅２３．１％出现Ⅱ，Ⅲ，ａＶＦ导联ＳＴ段压低≥０．１ｍＶ，两组间在统计学差异有极显著性。（２）６０     

Clinical significance of precordial ST segment depression during acute inferior myocardial infarction

To investigate the mechanisms and clinical significance of precordial (V1-V4) ST segment depression during acute inferior myocardial infarction, stress thallium-201 scintigrams and coronary angiograms were obtained within four to eight weeks after the onset of myocardial infarction in 37 patients experiencing their first acute inferior myocardial infarction. Among 18 patients with precordial ST depression (group 1), 11 with concomitant disease of the left anterior descending artery (LAD) had positive results on exercise test, whereas in seven patients without LAD lesion, only two had positive exercise test (p less than 0.01). In 19 patients without precordial ST depression (group 2), 11 had severe stenosis in the LAD. However, among these 11 patients, only two had positive exercise tests. Patients with precordial ST depression demonstrated a higher frequency of positive exercise tests than those without it (p less than 0.01). On stress thallium-201 scintigraphy, a perfusion defect involving the inferior wall was present in all patients, but additional anterior wall ischemia was present in only five of the 18 patients in group 1. These five patients had chest pain on exercise tests and a severe stenosis greater than 90% in the LAD. There was no significant difference in the frequency of additional posterolateral wall infarction between groups 1 and 2. In 18 patients in group 1, sigma ST (total degrees of ST segment depression in leads V1, V2, V3, and V4 in the acute stage) was significantly greater in 11 patients with LAD lesion than in seven without (p less than 0.05), and sigma ST greater than five mm was observed in 12 of 13 patients who had additional anterior wall ischemia and posterolateral wall infarction on stress thallium-201 scintigraphy (p less than 0.05). Myocardial revascularization, such as aortocoronary bypass surgery or percutaneous transluminal coronary angioplasty (PTCA), was performed in six of the 18 patients in group 1 in the chronic stage, but in only one of the 19 patients in group 2. Thus, in patients with initial acute inferior myocardial infarction, those with precordial ST depression seemed to be a high-risk group. It was suggested that, during the early stage of myocardial infarction, this abnormality on electrocardiograms is related to the summation of effects of anterior wall ischemia and posterolateral wall infarction. Furthermore, the sigma ST evaluation is useful in differentiating a mirror image of inferior wall infarction from anterior wall ischemia and posterolateral wall infarction as the mechanism of precordial ST depression.     

The clinical significance of exercise-induced ST segment changes in patients with previous inferior myocardial infarction

To investigate the clinical significance of exercise-induced ST changes, we performed exercise body surface mapping (87 leads) in 52 patients (one-vessel disease [1 VD] n = 12, multivessel disease [MVD] n = 40) with previous inferior myocardial infarction (MI). ST isointegral maps were constructed and the locations of ST changes were compared with the findings of exercise thallium-201 (TI-201) myocardial scanning. Exercise-induced ST elevation was observed in 14 patients (27%) on the lower chest and on the back, corresponding to the infarcted area. Exercise-induced ST depression was observed more frequently in the MVD group (n = 30, 75%) than in the 1VD group (n = 2, 17%). Seventeen (77%) of 22 patients with ST depression had thallium-201 redistribution. There was a significant association between ST depression and TI-201 redistribution (chi2 = 13.1, p less than 0.001), but no association between ST depression and ST elevation. The body surface distribution of ST depression was shifted upward and rightward compared with its appearance in angina pectoris without MI. These findings suggest that exercise-induced ST depression reflects myocardial ischemia in patients with previous inferior MI.     

急性下壁心肌梗死伴有胸前导联ST段压低的临床意义

目的 分析急性下壁心肌梗死（acute inferior myocardial infarction,AIMI）伴有胸前导联ST段压低的冠状动脉病变特点及临床意义。方法 回顾分析2006年8月～2007年8月住院的AIMI患者91例。按胸前导联ST段是否压低将患者分为4组:胸前导联ST段无压低组（n=27）;胸前导联仅V1～4 ST段压低组（n=26）;胸前导联仅V5～6 ST段压低组（n=12）;广泛胸前导联ST段压低组（n=26）。结果 AIMI伴有胸前导联V1～4 ST段压低与冠状动脉多支病变呈负相关,ORⅢ=0.38,无统计学意义;AIMI伴有胸前导联V1～6 ST段压低与冠状动脉多支病变呈正相关,ORⅣ=5.25,P<0.01,有显著统计学意义。胸前导联V1～6 ST段压低组与其他组相比较,左室射血分数（LVEF）低,差异显著（P<0.05）;该组前降支病变率高（73.1%）,但与其他3组相比无统计学差异。结论 AIMI伴有胸前导联V1～6 ST段压低提示多支病变,且心功能不全发生率高。     

急性下壁心肌梗死伴左胸导联ST段压低的临床意义

的　探讨急性下壁心肌梗死伴胸导联 ST段压低的临床意义。方法　选择收住院并行冠状动脉造影术的首发急性下壁心肌梗死患者 88例 ,按照胸导联有无 ST段下移分为不伴胸导联 ST段压低组 45例 ( ST段无压低或 ST段压低 <0 .1m V)及伴胸导联 ST段压低组 43例 ( ST段压低≥ 0 .1m V)。结果　伴胸导联 ST段压低组合并心力衰竭、严重心律失常、低血压及住院病死率较不伴胸导联 ST段压低组明显增高 ,冠状动脉造影显示左前降支病变及多支病变者显著增多。结论　急性下壁心肌梗死伴胸导联 ST段压低者其临床合并症多 ,预后差 ,冠状动脉多支病变及合并左前降支病变者显著增多 ,临床上应高度重视。     

急性下壁心肌梗死心电图胸前导联V1-3 ST段抬高的临床意义

目的 探讨急性下壁心肌梗死患者心电图胸前导联ST段抬高与冠状动脉造影所示冠状动脉病变的关系及其临床意义.方法 187例急性下壁心肌梗死患者,按入院时18导心电图胸前导联ST段改变分为2组,ST段抬高组（16例）和非ST段压低组（171例）.所有患者均行冠状动脉造影术,病变适合行经皮腔冠状动脉成型术并检测B型钠尿肽（BNP）.结果 急性下壁心肌梗死伴胸前导联ST段抬高时多为右冠状动脉近段闭塞,尤其是圆锥支闭塞（P＜0.01）,且伴有右心功能不全和血流动力学障碍,与下壁右室心梗相比BNP差异有统计学意义（P＜0.01）.结论 急性下壁心肌梗死合并胸前导联ST抬高表明为右冠状动脉近段或开口闭塞且多伴右室心肌梗死和心功能不全.     

急性广泛前壁心肌梗死并Ⅱ、Ⅲ、avF导联ST段压低的临床意义

目的　探讨急性前壁心肌梗死并心电图 、 、av F导联 ST段压低的临床意义。方法　随机选取 5 5例急性广泛前壁心肌梗死病人 ,根据入院时心电图 、 、av F ST段是否压低分为 ST段压低组 (n=35 )与 ST段无压低组 (n=2 0 )。 1月内作冠状动脉造影和心电图 ,比较两组病人合并其它冠状动脉病变的发生率、心功能及严重心律失常的发生率。结果　 ST段压低组合并其他冠状动脉病变的发生率为 77.14 % ,其中单支病变右冠状动脉 2 2 .86% ,左回旋支 17.14 % ,合并双支病变 37.14 % ,而无 ST段压低组合并其它冠状动脉病变的发生率为 15 .0 %。在广泛前壁加高侧壁心肌梗死 、 、av F ST段压低时合并其它冠状动脉病变的发生率为 12 .5 0 %。结论　急性广泛前壁心肌梗死伴 、 、av F ST段压低时多提示合并右冠状动脉和左回旋支病变 ,而广泛前壁加高侧壁心肌梗死并出现 、 、av F ST段压低更可能是一种对应性变化     

Clinical significance of PQ segment depression in acute Q wave anterior wall myocardial infarction

Objectives.This study was disigned to evaluate the clinical significance of PQ segment depression and to examine the frequency of PQ segment depression in infarction-associated pericarditis.Background. PQ segment deviation is almost as characteristic as the classic ST segment deviation and is detected in most patients with pericarditis. However, the incidence and clinical characteristics of PQ segment depression in acute myocardial infarction are not defined.Methods. Three hundred four consecutive patients with acute Q wave anterior wall myocardial infarction were examined carefully by auscultation, electrocardiogram, echocardiogram and chest roentgenogram. The diagnosis of pericarditis was made on the basis of pericardial rub detected by more than two observers during the 1st 3 days after hospital admission. At least 0.5 mm of PQ segment depression from the TP segment observed for >24 h in both limb and precordial loads was considered diagnostic of PQ segment depression.Results. A pericardial rub was present in 65 patients (21 %) and absent in 239 patients. PQ segment depression was detected in both limb and precordial loads in 30 patients (10%): 18 patients with pericardial rub and 12 patients without pericardial rub. On the basis of five clinical variables, multivariate analysis was performed to determine the important variables related to the occurrence of PQ segment depression. Pericardial rub was selected with left ventricular segments with advanced asynergy as a significant factor related to PQ segment depression. There were 31 in-hospital deaths, and a significantly higher hospital mortality rate was observed in patients with PQ segment depression (23% vs. 9%).Conclusions. Although PQ segment depression was observed in a minority of patients with infarction-associated pericarditis, it was one of the clinical signs of larger infarct size and increased hospital deaths.     

急性前壁心肌梗死R波、Q波和ST段演变速度的观察

目的 通过心电图对急性心肌梗死的诊断提供更多的信息。方法 对21例急性前壁心肌梗死患者进行R波、Q波和ST段变化进行同步12导联心电图动态观察。将开始到结束的7次标测分成6个时间间隔．分别计算各个时间间隔的∑R、∑Q、和∑ST的平均值和标准差。结果∑R于胸痛发作后12h内迅速下降；∑Q逐渐增大，24h内变化最显著；EST 12h内迅速下降，48h后渐趋稳定。12例（57％）R波消失，Q波在发病后12h内形成；另9例（43％）于24h内形成。结论心肌梗死后ST段抬高、R波下降和Q波形成在快速型和慢速型心肌梗死患者中不同。     

急性下壁心肌梗死胸前导联ST段下移的临床意义

目的 探讨下壁急性心肌梗死时胸前导联心电图前壁ST段下移的意义。方法 对60例急性下壁心肌梗死病人的早期心电图及入院后3周内冠状动脉造影和心肌酶检查结果对照分析。结果 胸前导联ST段下移者41例(68%),多支病变39例,单支病变2例,胸导联ST段无下移者19例,多支病变4例,单支病变15例(P<0.01),而且前者有较高的CK峰值(P相似文献   

急性下壁心肌梗死伴胸前导联ST段压低的临床意义

评价急性下壁心肌梗死伴胸前导联ＳＴ段压低的临床意义。方法３３例急性下壁心肌梗死患者早期心电图与入院后３周冠脉造影对照，观察急性下壁心肌梗死伴胸前导联ＳＴ段压低与左前降支、多支血管病变、心肌酶峰值、ＳＴⅡ抬高〉ＳＴ；及右冠病变部位关系。     

急性前壁心肌梗死下壁导联ST段压低的临床价值

目的 探讨急性前壁透壁性心肌梗死时下壁导联ST段压低的临床价值。方法 比较任一下壁导联ST段压低≥1.0mm的17例与压低均＜1．0mm的16例的CK－MB值、超声心动描记术、冠状动脉造影等结果。结果 前组CK－MB值更高,射血分数减低更显著,左室收缩与舒张末期容积更大,造影术示致梗死狭窄病变多位于左前降支近端或呈多支病变。结论 急性前壁心肌梗死下壁导联ST段压低≥1.0mm时,其梗死面积较大,会发生较严重的左室射血功能损害及左心室重构。     

Dipyridamole echocardiography evaluation of acute inferior myocardial infarction with concomitant anterior ST segment depression

The significance of anterior ST segment depression in inferioracute myocardial infarction (AMI) remains controversial. Theaim of this study was to relate precordial ST segment depressionto the topography of residual myocardial ischaemia, with myocardialmapping of the asynergic area and coronary anatomy. Twenty-fivepatients with first inferior AMI (15 patients with anteriorST segment depression: group A and 10 patients without anteriorST segment shift: group B), all underwent: (1) electrocardiographicevaluation on admission to the Coronary Care Unit and at 24h intervals thereafter; (2) 2D-echocardiographic study within3 h of CCU admission: (3) dipyridamole echocardiographic test(DET) (doses of dipyridamole up to 0.84 mg.kg^–1 i.v. over10 min) 4 days after AMI; (4) coronary arteriography within14 days from AMI. To assess regional left ventricular wall motion,a 16 segment model was used and a wall motion score index (WMSI)was derived. The results of DET were correlated to the anatomyof the infarct-related vessel. Compared to group B, group Apatients showed a significantly greater maximal ST segment elevationin inferior limb leads (lead III: 3.9±1.9 mm vs 2.2±1.1mm, P<0.05; aVF: 3.5±13 mm vs 1.7±0.8 mm, P<0.001).Group A patients showed greater WMSI (1.35±0.22 vs 117±0.12,P<0.05), with more frequent postero-lateral wall involvement(72% vs 20%, P<0.05). No patient of either group showed asynergyof the anterior, anterolateral or anteroseptal segments. Nodifferences in the distribution of coronary artery disease wereobserved. Left anterior descending coronary artery disease waspresent in only three patients (20%) in group A and in one patientin group B. DET was positive in eight patients (53%) in groupA and in three (30%) in group B (P = statistically not significant).In all patients DET induced new wall motion abnormalities locatedin the territory of the infarct-related artery. None of thepatients developed new wall motion abnormalities remote fromthe infarct zone or adjacent to the infarct zone, but locatedin different vascular regions. In conclusion, anterior ST segmentdepression in inferior A MI appears to indicate a more extensivearea of asynergy, with frequent involvement of the posterolateralwall. The topography of DET-induced residual myocardial ischaemiadoes not support the hypothesis of concomitant anterior ischaemia.     

急性下壁心肌梗死伴胸导联ST段压低的临床意义

目的探讨急性下壁心肌梗死伴胸导联ST段压低的临床意义。方法观察64例急性下壁心肌梗死胸导联ST段压低与常规及24h动态心电图检查结果的关系。结果①单纯下壁心肌梗死不伴胸导联ST段改变显著多于伴胸导联ST段改变(P<0.01),下壁伴正后壁心肌梗死伴胸导联ST段改变显著多于不伴胸导联ST段改变(P<0.01),而下壁伴右心室心肌梗死与胸导联ST段改变无明显区别(P>0.05)。②伴胸导联ST段改变者严重室性心律失常与房室传导阻滞的发生率均较不伴胸导联ST段改变者高(P<0.05)。结论急性下壁心肌梗死伴胸导联ST段压低表明心肌梗死广泛,严重室性心律失常和房室传导阻滞的发生率明显增多。