16导联心电图ST段改变对急性心肌梗死的临床价值

目的探讨16导联心电图中ST段改变对急性心肌梗死的临床诊断价值。方法对332例急性心肌梗死患者,在原有标准12导联的基础上,增加后壁导联（V7和V8）和右胸导联（V4R和V5R）,观察附加导联中ST段改变,是否可提高心电图诊断急性心肌梗死的价值。结果12导联心电图诊断急性心肌梗死的敏感性为71.4%,特异性为86.0%;12导联＋后壁导联诊断急性心肌梗死的敏感性为79.2%,特异性为85.0%;12导联＋右胸导联诊断急性心肌梗死的敏感性为75.3%,特异性为84.5%;12导联＋后壁＋右胸导联诊断急性心肌梗死的敏感性为81.9%,特异性为83.7%。结论增加后壁和右胸导联可提高诊断急性心肌梗死的敏感性,而特异性并无显著降低。     

右胸头胸导联心电图病理性Q波意义探讨

描记１３５例（正常人２２例，心绞痛１４例，非Ｑ波梗塞１０例，前壁梗塞２５例，下壁右室梗塞３６例）右胸头胸导心电图ＨＶ３Ｒ－ＨＶ７Ｒ，发现前３组共４６例右胸心电图正２２例（８８％），３例有左前降支冠脉闭塞，左室扩大合并心室壁瘤患者，ＨＶ３Ｒ，ＨＶ４Ｒ出现Ｑ波，ＨＶ５Ｒ－ＨＶ７Ｒ正常。下壁梗塞组心电图正常５例（１８％），Ｑ波主要分布在ＨＶ５Ｒ－ＨＶ７Ｒ。下壁合并右室梗塞组全部病例ＨＶ６Ｒ，ＨＶ７Ｒ均含     

Isolated Right Ventricular Infarction: A Case Report and Literature Review

Isolated right ventricular (RV) infarction is extremely rare and its diagnosis may be challenging, because RV infarction most often occurs simultaneously with infarction of the inferior wall of the left ventricle. A 66-year-old man with a history of diabetes mellitus presented with cold sweat and general malaise. Although his symptoms were atypical for myocardial infarction, he was quickly diagnosed with RV infarction and successfully underwent urgent percutaneous coronary intervention. He was definitely diagnosed with isolated RV infarction by a scintigram and cardiac magnetic resonance imaging. Our review showed the importance of the combined assessment in the diagnosis of isolated RV infarction.     

致心律失常性右心室心肌病右胸导联QRS时间延长的临床意义

目的探讨致心律失常性右心室心肌病右胸导联QRS时间延长的临床意义。方法收集致心律失常性右心室心肌病25例,分析临床和常规体表心电图特征,测量QRS时间、Q-T间期等各项参数,计算右胸导联(V1～V3)和左胸导联(V4～V6)QRS时间的平均值及两者之比。结果25例致心律失常性右心室心肌病病例的年龄(37.1±15.0)岁,其中男性12例,女性13例。常规心电图中Epsilon波阳性(第1组)11例(44.0%),其中63.6%(7/11)见于V1～V3导联;Epsilon波阴性14例(第2组)。所有患者的平均QRS离散度为36.3±27.2ms,Q-T离散度为57.2±27.1ms。平均QRS时间右胸导联[QRS1=(V1+V2+V3)/3]为0.13±0.03s,而左胸导联[QRS2=(V4+V5+V6)/3]为0.11±0.02s,差异有非常显著性意义(P<0.01)。QRS1/QRS2值为1.0～1.9,其中16例(61.5%)≥1.2。发生晕厥第1组8例(72.7%),而第2组4例(28.6%)(P<0.05)。两组的QRS1分别为0.14±0.04s、0.13±0.02s,QRS2分别为0.12±0.03s和0.11±.017s,QRS1/QRS2值为1.22±0.26和1.21±0.13,差异均无显著性意义(P>0.05)。结论右胸导联平均QRS时间延长有助于诊断致心律失常性右心室心肌病,但能否作为致心律失常性右心室心肌病预后的不良因素尚须进一步研究。     

Electrocardiographic findings in leads V3R to V5R in patients with a slurred or notched S wave in lead V~

Background Right bundle branch block (RBBB) may present as slurred or notched S wave in lead V 1 . However, slurred or notched S wave may also represent slow conduction in the myocardium. Methods We retrospectively analyzed the QRS patterns in leads V3R to V5R in 7 patients with a slurred or notched S wave in lead V 1 . Results In the leads V 3R to V 5R , 6 patients showed incomplete or complete RBBB and 1 patient slurred or notched S wave. Conclusions In the majority of ECGs in a small patient series with slurred or notched S wave in lead V 1 , QRS morphology indicating incomplete or complete RBBB was present in leads V 3R to V 5R . A finding of fragmented QRS in these leads may indicate slow conduction in the myocardium.     

正常人右胸导联心电图P波形态及性别差异

目的 探讨正常人右胸导联心电图男女P波形态差异及变化规律.方法 测量900名正常人右胸导联心电图,男女对半,分析P波形态及变化规律.结果 右胸导联心电图P波以直立和正负双相P波为主.V1导联直立P波的发生率明显多于正负双相P波的发生率(P<0.01).从V1～V6R直立P波的发生率依次减少,正负双相P波的发生率依次增多...     

右胸导联V4R和V5R对由右冠脉近段阻塞引起的急性ST段抬高型心肌梗死的诊断价值

目的与右冠脉阻塞关联的ST段抬高型右室心肌梗死,住院期死亡率高。本研究假设是:右胸导联(V4R和V5R导联)有助于发现ST段抬高型右室心肌梗死。1342例患者记录12导联加右胸导联心电图。结果右冠脉近段阻塞者,V4R和V5R导联常见有ST段抬高,同时伴有Ⅰ,aVL,V5和V6导联ST段压低;常规12导联心电图通常不能发现ST段抬高。结论对于急性冠脉综合征,提高对ST段抬高型心肌梗死诊断的敏感性,常规12导联附加右胸导联是一项简便的方法。     

Significance of ST-Segment elevation in V4R lead in patients with anterior myocardial infarction

Background

There is some evidence of the association between ST-segment elevation in the V4R chest lead and the likelihood of anterior wall myocardial infarction; however, the link of this phenomenon with the location and the severity of the coronary involvements in such patients remains uncertain. We aimed to investigate the ST-segment elevation in V4R leads in patients with anterior myocardial infarction and also its effect on prognosis as well as the detection and prediction of the location of arterial stenosis in coronary angiography.

Methods

Data collection was performed by reviewing the hospital recorded files of 195 patients’ suspicion of acute myocardial infarction who have been referred within 2 h of the onset of cardiac symptoms. The patients were then categorized into two groups with and without ST elevation in the V4R chest lead.

Results

Comparing two groups showed a significantly higher rate of concurrent ST-segment elevation in V₁ lead in those with ST-segment elevation in V4R. Echocardiography on the day after anterior myocardial infarction showed LVEF <40% in 74% and 35.2% of patients with and without ST-segment elevation in V4R, respectively, indicating a significant difference. The lesions on proximal LAD were more common in the group with ST-segment elevation in V4R.

Conclusion

Our study emphasized a high likelihood of ST-segment elevation in V4R lead concurrently with ST-elevation in V₁ lead. Also, the appearance of ST-segment elevation in V4R lead can be accompanied with a lower LVEF, myocardial infarct size, involvement of proximal part of LAD, and Wrap around LAD.

     

Significance of ST‐Segment elevation in V4R lead in patients with anterior myocardial infarction

BackgroundThere is some evidence of the association between ST‐segment elevation in the V4R chest lead and the likelihood of anterior wall myocardial infarction; however, the link of this phenomenon with the location and the severity of the coronary involvements in such patients remains uncertain. We aimed to investigate the ST‐segment elevation in V4R leads in patients with anterior myocardial infarction and also its effect on prognosis as well as the detection and prediction of the location of arterial stenosis in coronary angiography.MethodsData collection was performed by reviewing the hospital recorded files of 195 patients’ suspicion of acute myocardial infarction who have been referred within 2 h of the onset of cardiac symptoms. The patients were then categorized into two groups with and without ST elevation in the V4R chest lead.ResultsComparing two groups showed a significantly higher rate of concurrent ST‐segment elevation in V₁ lead in those with ST‐segment elevation in V4R. Echocardiography on the day after anterior myocardial infarction showed LVEF <40% in 74% and 35.2% of patients with and without ST‐segment elevation in V4R, respectively, indicating a significant difference. The lesions on proximal LAD were more common in the group with ST‐segment elevation in V4R.ConclusionOur study emphasized a high likelihood of ST‐segment elevation in V4R lead concurrently with ST‐elevation in V₁ lead. Also, the appearance of ST‐segment elevation in V4R lead can be accompanied with a lower LVEF, myocardial infarct size, involvement of proximal part of LAD, and Wrap around LAD.     

A new Q/QS pattern on the resting electrocardiogram is associated with impaired insulin secretion and a poor prognosis in elderly men independently of history of myocardial infarction

OBJECTIVES: To evaluate risk factors and prognosis of subjects who had developed a new Q/QS pattern on the resting electrocardiogram (ECG) in relation to history of myocardial infarction (MI). DESIGN: Cross-sectional and prospective population-based cohort study. SETTING: Uppsala, Sweden. SUBJECTS: In 1970-73, all 50-year-old men in Uppsala, were invited to participate in a health survey aimed at identifying risk factors for cardiovascular disease. The present study included the 1221 subjects who also were re-examined at age 70. RESULTS: Subjects with a new Q/QS pattern on the resting ECG at age 70 were characterized by impaired insulin secretion compared with those without Q/QS, and a higher prevalence of diabetes compared with the control group. In Cox proportional hazard analysis a new Q/QS pattern at age 70 was a significant predictor of cardiovascular mortality (hazard ratio : 1.67, 95% CI: 1.22-2.26) and total mortality (hazard ratio: 1.31, 95% CI: 1.04-1.62) (after age 70) during 9.4 years follow-up, also when adjusted for other risk factors and MI diagnosis. CONCLUSION: The finding of a new Q/QS pattern on the resting ECG, regardless of history of MI was associated with impaired insulin secretion and was an independent predictor of total and cardiovascular mortality. Therefore, these subjects must be given a high priority to preventive measures against both coronary heart disease and diabetes.     

ST段抬高急性心肌梗死的梗死相关动脉临床心电图诊断

急性心肌梗死是指因持续而严重的心肌缺血所致的部分心肌急性坏死.了解梗死相关动脉对急性心肌梗死的诊断起了决定性的作用.临床诊断冠脉病变常运用冠脉造影的方法,需要昂贵的设备和有一定条件的医院才能够做到.而使用心电图诊断ST段抬高急性心肌梗死的梗死相关动脉临床简单、易行.最近有不少研究都证明了该方法是可行的,现就此作一综述.     

Amplitude of the Electrocardiographic QRS Complexes during and after Severe Pulmonary Edema

There is recent evidence that anasarca peripheral edema, irrespective of its etiology, attenuates ECG QRS potentials. Pulmonary edema (PE) also is thought to cause reduction in the amplitude of QRS complexes. The case reported herein is of a patient with severe PE, hypertension, left ventricular diastolic dysfunction, and no peripheral edema who did not show changes in the QRS complexes with the management of her pulmonary edema. Thus it appears that PE does not attenuate the amplitude of QRS complexes, and alleviation of this condition does not cause augmentation of QRS voltage. This is in contrast to alterations of peripheral edematous states in the setting of congestive heart failure, which result in changes in the QRS amplitude, as shown previously.     

心室壁心肌肿瘤的临床和心电图特点

目的 :总结心室壁心肌肿瘤的临床和心电图特点 ,意旨早期诊断。　　方法 :对 1992年 12月～ 1999年 7月 5例经心脏影像检查发现并经手术和病理证实的心室壁心肌肿瘤患者的临床和心电图特点进行总结分析。　　结果 :本组 5例经病理证实为心室壁心肌肿瘤 ,其中 ,左心室心肌海绵体瘤 ,脂肪瘤、浸润性脂肪瘤、左心室和双心室心肌纤维瘤各 1例。 5例均以室性心动过速 (VT)为首发临床表现 ,心室率在 16 0～ 2 0 0次 /分 ;心电图 (ECG)均有酷似心肌梗塞改变 ,包括异常 Q波 2例 ,ST段抬高 2例 ,T波深度倒置 5例 ,又均无明确的心肌梗塞史 ;而且 ,肿瘤部位与 ECG异常所在导联和 VT起源部位基本一致 ,其中 1例经心内电生理证实。　　结论 :1对临床上以 VT为主要表现 ,并有 ECG酷似心肌梗塞改变又无明确心肌梗塞病史的患者 ,应高度疑诊为心室壁心肌肿瘤 ,并行影像学检查确诊。 2 ECG示酷似心肌梗塞所累及导联和 VT起源部位对心室壁心肌肿瘤有定位价值     

右心室间隔部起搏的安全性及可行性研究

目的 评估在接受心室起搏的患者中,应用右室间隔部起搏技术的安全性与可行性。方法:慢性心房颤动伴长RR间歇或缓慢心室率需植入水火起搏器患者10例,男性7例,女性3例,平均年龄64.20±12.61岁;心功能正常2例,NYHA Ⅰ级3例,Ⅱ级3例,Ⅳ级2例,因慢性心房颤动所有患者采用抑制型按需心室起搏模式(VVI)。术中首先将螺旋电极固定于右室心尖部(RVA),15分钟后测试起搏阈值;然后将螺旋电极移开右室心尖部,在X光影像学和心电图提示下,将螺旋电极最终固定于右室间隔部(RVS),15分钟后测试起搏阈值。结果 术中10例患者利用螺旋电极均成功进行了RVS的固定,未发生螺旋电极导线的移位、脱位或其它并发症。右室间隔部起搏阈值电压为0.73±0.36V,电流1.14±0.44mA,阻抗646.20±130.52Ω,R波振幅12.14±3.41mV。结论 对于慢性心房颤动伴长RH间歇或缓慢心室率患者,利用螺旋电极进行右室间隔部起搏可行且较为安全。     

急性心肌梗死合并室间隔穿孔的临床及预后分析

目的:探讨急性心肌梗死(AMI)后发生室间隔穿孔的临床特征、冠状动脉造影表现、治疗方法及预后情况.方法:我院1996年1月至2003年12月期间收治急性透壁心肌梗死1 881 例,发生室间隔穿孔13例,穿孔发生率0.69%.另有22例因AMI已并发室间隔穿孔而转来我院的患者,共35例进行分析.其中男性24例(68.6%),女性11例(31.4%).结果:资料分析结果21例(60.0%)合并高血压病,18例(51.4%)有吸烟史.前壁心肌梗死31例(88.6%),下后壁心肌梗死4例(11.4%).22例患者施行了冠状动脉造影,梗塞相关血管前降支占81.8%,完全闭塞占72.7%.心原性休克21例(60.0%),心功能Ⅳ级26例(74.3%),Ⅲ级9例(25.7%).室间隔穿孔多发生在AMI后1周内(91.4%).超声心动图提示室间隔缺损,穿孔直径范围0.5～2.8 cm,多数位于室间隔近心尖部.7例(20%)进行溶栓治疗,但未成功.21例(60%)施行外科手术治疗,全部存活.14例药物治疗,仅1例存活,死亡13例,总病死率37.1%,药物治疗病死率92.9%.结论:AMI并发室间隔破裂并不常见,多发生在广泛前壁心肌梗死的患者,多数迅速发展至心原性休克,内科治疗病死率很高;如药物治疗能维持血流动力学稳定至穿孔后4周手术,外科治疗可提高生存率.     

梗死性室性异位心搏的临床及心电学特点

探讨梗死性室性异位心搏 (IVEB)的临床及心电学特点。对 2 4例在急性心肌梗死 (AMI)时出现IVEB的患者与同期住院的 71例无IVEB的AMI患者进行回顾性对照分析 ,并比较IVEB和同期与梗死充分进展期窦性心律的QRS ST T波群形态学改变。结果 :①IVEB的QRS波常呈右束支阻滞形态 (RBBBM) ,除Q波型AMI外 ,非Q波型AMI亦可发生IVEB ;②下 (后 )壁伴或不伴右室AMI、大面积AMI、梗死后心功能差、梗死早期 (<6h)及接受溶栓治疗冠状动脉再通者易发生IVEB ;③与同期窦性心律比较 ,IVEB梗死导联Q波出现及ST段抬高提早 ,且更具有AMI的特征 ;④IVEB可发生于心肌酶谱升高及窦性心律典型AMIECG图形出现之前 ,其对AMI的早期诊断及定位优于同期窦性心律。结论 :IVEB并非罕见 ,它有利于AMI的早期诊断与定位