室上性心动过速时缺血型ST段下移与冠心病的关系

探讨室上性心动过速时缺血型ST段下移与冠心病的关系。分析48例室上性心动过速发作时出现ST段下移并行冠状动脉造影者的临床和心电指标,发现23例(47.92%)有冠心病,年龄越大,室上性心动过速缺血性ST下移动诊断冠心病价值越高。     

阵发性室上性心动过速时ST段压低对冠心病的诊断价值

为探讨阵发性室上性心动过速时ST段压低对冠心病的诊断价值 ,选择 4 5例年龄 >4 5岁无冠心病临床证据拟行腔内电生理检查和 (或 )射频消融术的阵发性室上性心动过速患者 ,按其发作时有无ST段压低分为两组 ,两组患者均行冠状动脉造影术并对每例进行冠心病危险因素积分。结果发现 ,伴ST段压低组 2 4例中有 9例 (37.5 % )有冠心病 ,无ST段压低组 2 1例中无一例有冠心病 (P <0 .0 5 ) ,在ST段压低组中有无冠心病间的唯一差异是冠心病危险积分。结果提示 ,在年龄 >4 5岁的阵发性室上性心动过速患者中 ,冠心病是导致伴ST段压低的原因之一 ,对此类患者 ,特别是伴有冠心病危险因素的患者应考虑行冠状动脉造影 ,以便对合并的冠心病进行早期诊断和治疗     

阵发性室上性心动过速患者ST段压低诊断冠心病的价值

探讨阵发性室上性心动过速(PSVT)发作时ST段压低是否由冠心病心肌缺血引起。对23例40岁以上窄QRS波的PSVT伴有1个以上导联ST段压低至少1mm的患者的心电图、冠心病危险因素和冠状动脉造影资料进行分析。结果:PSVT发作时ST段压低最大值与年龄、冠心病危险因素积分和心率均无明显相关性。23例患者中仅26%的患者诊断为冠心病;冠心病组与非冠心病组的冠心病危险因素积分有显著性差异,但二组性别、年龄、PSVT发作时心率、胸痛的发生率和ST段压低值均无显著差异。结论:40岁以上PSVT患者发作时ST段压低诊断冠心病的预测值较低,冠心病心肌缺血不是引起PSVT发作时ST段压低的唯一机制。     

室上性心动过速时ST段压低对冠心病的诊断价值

目的 :探讨阵发性室上性心动过速 (PSVT)时 ST段压低对冠心病 (CAD)的诊断价值。方法 :将 40例年龄 >45岁无 CAD临床证据的 PSVT患者分为两组 :A组在 PSVT时伴 ST段压低 ,B组无压低。两组患者均行运动试验和冠状动脉造影。结果 :A组 2 0例中 8例 (40 % )有 CAD;B组 2 0例中无一例有 CAD(P <0 .0 5)。结论 :在 >45岁 PSVT患者中 ,CAD和心肌缺血是导致伴 ST段压低的原因之一。即使无 CAD的临床表现 ,此类患者亦应考虑行运动试验或冠状动脉造影 ,以便早期发现和治疗并存的 CAD。     

阵发性室上性心动过速合并ST段压低对心肌缺血的诊断价值

目的探讨房室结内折返性心动过速（AVNRT）与房室折返性心动过速（AVRT）发作时合并心电图ST段压低对心肌缺血的诊断价值。方法对98例阵发性室上性心动过速（PSVT）患者行心内电生理检查＋射频消融术,并对PSVT合并ST段压低的患者行冠状动脉造影术。分组比较两种心动过速发作时合并ST段压低程度的差异,以及两种心动过速合并ST段压低时心肌缺血检出率的差异。结果 AVRT与AVNRT组合并ST段压低者分别占46.4%和26.0%,两组比较差异有统计学意义（P〈0.05）。两种室上性心动过速合并ST段压低时冠心病检出率分别为34.6%和36.3%,比较无统计学差异。合并冠心病者冠状动脉危险因素积分高于非冠心病者（P〈0.05）。结论 PSVT合并ST段压低对诊断冠心病的预测价值较低,AVRT比AVNRT更容易合并心电图ST段压低,且前者合并ST段压低程度高于后者。     

aVR导联ST段抬高对阵发性室上性心动过速的鉴别价值

目的探讨aVR导联ST段抬高及其持续时间对阵发性室上性心动过速（PSVT）的鉴别价值。方法126例行射频消融治疗成功的PSVT患者，其中房室折返性心动过速（AVRT）65例，房室结折返性心动过速（AVNRT）61例。分析其aVR导联ST段抬高幅度及持续时间。结果65例AVRT中aVR导联ST抬高且持续时间≥0．08s有46例，61例AVNRT中有13例，诊断AVRT的敏感性、特异性及阳性预测值分别为70．8％，78．7％，78．0％；46例aVR导联ST段抬高的AVRT中左侧旁道占38例，诊断左侧旁道的敏感性、特异性及阳性预测值分别为79．2％，52．9％，82．6％。结论aVR导联ST段抬高及其持续时间有助于鉴别阵发性室上性心动过速，且其多发生于左侧旁道。     

阵发性室上性心动过速ST段压低患者冠脉造影结果分析

目的 探讨阵发性室上性心动过速（PSVT）发作时ST段压低患者冠状动脉造影结果的影响因素及与ST段压低形态的关系。方法 选取PSVT发作时伴ST段压低,且已行腔内电生理检查及冠状动脉造影术的患者74例,根据冠状动脉造影结果分为造影阴性组（n=47）与造影阳性组（n=27）。比较两组患者临床资料、血液生化指标、PSVT类型、10年动脉粥样硬化性心血管疾病（ASCVD）风险及ST段压低形态,分析冠状动脉造影结果的影响因素。结果 与冠状动脉造影阴性组相比较,造影阳性组患者年龄更大（63±10 vs. 55.2±9）岁, P<0.01,合并高血压的比例更高（48%vs. 15%）,P<0.01,出现胸闷/胸痛症状的比例更高（96%vs. 66%）, P<0.05,但出现心悸症状的比例显著降低（82%vs. 98%）, P<0.05,而10年ASCVD风险显著增高（P<0.01）。两组患者ST段压低形态无显著差异。单因素分析中,年龄、心悸症状、胸闷/胸痛症状、高血压、10年ASCVD风险对冠状动脉造影结果有影响。多因素Logistic回归分析表明胸闷/胸痛症状（OR...     

aVR导联ST段抬高对阵发性室上性心动过速的鉴别价值

目的探讨aVR导联ST段抬高及其持续时间对阵发性室上性心动过速(PSVT)的鉴别价值。方法126例行射频消融治疗成功的PSVT患者,其中房室折返性心动过速(AVRT)65例,房室结折返性心动过速(AVNRT)61例。分析其aVR导联ST段抬高幅度及持续时间。结果65例AVRT中aVR导联ST抬高且持续时间≥0.08s有46例,61例AVNRT中有13例,诊断AVRT的敏感性、特异性及阳性预测值分别为70.8%,78.7%,78.0%;46例aVR导联ST段抬高的AVRT中左侧旁道占38例,诊断左侧旁道的敏感性、特异性及阳性预测值分别为79.2%,52.9%,82.6%。结论aVR导联ST段抬高及其持续时间有助于鉴别阵发性室上性心动过速,且其多发生于左侧旁道。     

老年人ST段水平延长对冠心病的诊断价值

目的:探讨老年疑似冠心病患者心电图中ST段水平延长≥0.12s在冠心病心肌缺血辅助检测中的作用,通过这一新的心电图学指标以提高冠心病诊断的效果.方法:184例老年疑似冠心病患者,其中ST段水平延长≥0.12s的老年患者100例(延长组),ST段<0.12 s老年患者84例(非延长组),均做冠状动脉造影.结果:冠状动脉造影阳性率与ST段是否延长差异有统计学意义(P<0.001).延长组中,男性阳性者58例(93.5%),女性26例(68.4%),差异有统计学意义(P<0.01).结果判断,延长组诊断冠心病的敏感性89%,特异性82%,阳性预测值84%,阴性预测值88%.结论:ST段水平延长≥0.12 s老年患者心肌缺血可能性大,ST段水平延长≥0.12 s可作为那些既不愿意做冠状动脉造影又不能做心脏负荷试验的老年人诊断冠心病的一个辅助指标.     

巨R波型ST段抬高的室上性心动过速1例

巨R波形ST段抬高临床上尚属罕见,往往呈一过性改变,常规心电图不容易记录到。它常见于急性心肌梗死超急性期,预示病情危重,对其及时诊断和治疗有助于明显改善预后。现报道常规心电图表现巨R波形ST段抬高的室上性心动过速患者1例。     

Value of ST-segment depression during paroxysmal supraventricular tachycardia in the diagnosis of coronary artery disease

We evaluated 39 patients >45 years old with paroxysmal supraventricular tachycardia (SVT), 21 of whom had ST-segment depression during SVT. Treadmill exercise testing, including thallium stress scintigraphy, was performed in all patients and coronary angiography in 21 patients with ST-segment depression. Based on the presence of abnormal findings on exercise electrocardiogram and/or thallium in 7 of 21 patients (33%) with ST-segment depression, with additional corroboration by angiographic data, we conclude that myocardial ischemia and coronary artery disease is one, but not the only, mechanism involved in the genesis of ST-segment depression during paroxysmal SVT.     

Significance of ST segment depression during paroxysmal supraventricular tachycardia

During paroxysmal supraventricular tachycardia, patients frequently experience chest pain and marked ST segment depression suggesting acute myocardial ischemia. The purpose of this study was to assess whether ST depression during supraventricular tachycardia is caused by myocardial ischemia as reflected by net myocardial lactate production. Twenty-five patients (14 men, 11 women) who had a history of paroxysmal supraventricular tachycardia and a mean age (+/- SD) of 38 +/- 14 years underwent electrophysiologic testing. Twenty-four of these patients had no evidence of coronary disease, whereas one patient had undergone previous coronary bypass surgery. Nineteen patients had orthodromic and six patients had atrioventricular node reentrant tachycardias. A 12 lead electrocardiogram and simultaneous femoral artery and coronary sinus blood samples for lactate determinations were obtained at baseline and at 5 and 10 min of supraventricular tachycardia. Mean baseline heart rate of 83 +/- 12 beats/min increased to 180 +/- 25 beats/min during supraventricular tachycardia. All patients had 1 to 8 mm of ST segment depression in 1 to 9 of the 12 leads. Chest pain occurred in 64% of patients during supraventricular tachycardia. Baseline myocardial lactate extraction was 28 +/- 13% with no significant change at 5 or 10 min of tachycardia. In contrast, in a comparison group of seven patients with known coronary artery disease, atrial pacing at 168 +/- 26 beats/min in five patients resulted in greater than or equal to 1 mm ST depression in 2 to 7 of the 12 leads and a change in lactate extraction from a baseline of 29 +/- 13% to -27 +/- 20% (p less than 0.05) indicating net myocardial lactate production.(ABSTRACT TRUNCATED AT 250 WORDS)     

ST-segment depression and elevation during supraventricular tachycardias

Three electrocardiograms with repolarisation abnormalities (ST-segment depression and elevation) during supraventricular tachycardias are presented. In all three cases the subjects were young and otherwise healthy. Despite this in one of these cases an acute coronary syndrome was erroneously diagnosed on the basis of pronounced ST-segment depression in several leads and troponin I elevation. Coronary angiogram and echocardiogram in this case was normal. Diagnostic value and aetiology of repolarisation abnormalities during supraventricular tachycardias are discussed.     

静脉注射胺碘酮对冠心病快速型室上性心动过速的疗效

目的:观察静脉注射胺碘酮治疗冠心病快速型室上性心律失常(SVT)的疗效。方法:入选冠心脏病合并SVT患者,心动过速发作1～6h 79例,随机分为胺碘酮组(41例,脉注射胺碘酮150～450mg或改为静脉恒速泵注入),毛花甙C组(38例,静脉注射毛花甙C 0.4～1.0mg),观察其心率、QT间期变化及药物副作用。结果:两组心率均有明显控制,肢碘酮和毛花甙C组对STCA的有效率分别为92.6％与73.6％,胶碘酮疗效高于毛花甙C(P<0.01),QT间期及副作用差异无显著性意义。结论:胺碘酮对冠心病并SVT者的疗效显著高于毛花甙C。     

阵发性室上性心动过速合并肌钙蛋白升高对冠心病的诊断意义

目的:探讨阵发性室上性心动过速(PSVT)发作时合并血清肌钙蛋白(cTnI)升高对冠心病的诊断意义。方法:对以突发心悸作为首发症状并通过体表心电图、食管调搏或心内电生理检查诊断为PSVT的患者,在起病24 h内检测cTnI,并在住院期间进行冠脉造影检查。共入选21例PVST患者,其中cTnI正常组5例(cTnI 0. 0262 ng/mL),cTnI显著升高组(cTnI 0. 3 ng/mL) 5例,cTnI临界组(0. 0262～0. 3 ng/mL)组11例。结果:冠脉造影结果提示冠心病例数:cTnI正常及临界组0例,cTnI显著升高组3例。cTnI正常组与临界组冠心病发生率相比差异无统计学意义,cTnI显著升高组较临界组有统计学意义(P 0. 05)。结论:PSVT患者发作时可导致cTnI水平升高,当cTnI显著升高时,需警惕合并冠心病可能。