特发性异常J波与Brugada综合征的临床及心电图特征

目的探讨特发性异常J波与Brugada综合征的临床及心电学特点。方法对特发性异常J波与Brugada综合征各8例进行分析。结果①特发性异常J波在肢导联或(和)胸导联可见正向异常J波[除aVR(部分患者aVL)外],其波幅较低而分布较广,一般V1~V2导联不出现J波,若出现则JV1~V2R,TV1~V2(V3)倒置或直立。两者均易诱发多形性室性心动过速及/或心室颤动而致死。结论异常J波和Brugada综合征及Brugada样心电图象是具有不同临床及心电学特点的临床病症。     

Brugada波与Brugada综合征的诊断与鉴别

1 定义 类似右束支传导阻滞(RBBB)伴持续性右胸导联ST段抬高的心电图特征,称为Brugada波。类似RBBB、持续性右胸导联ST段抬高伴发室速、室颤和猝死,称为Brugada综合征。 2 Brugada波回顾     

Brugada波与特发性J波

一、Brugada波Brugada波的典型心电图表现是 ,右胸前V1～V3 导联的ST段抬高和右束支阻滞共同称为Bru gada波。因此 ,正确识别Brugada波对诊断Brugada综合征是十分重要的。1.Brugada波的典型心电图特点⑴右胸前导联的ST段抬高 :右心室肌的期前复极和 或传导延迟引起的右胸前导联V1～V3 的ST段抬高 ,呈穹隆型或马鞍型及下斜型两种表现 ,偶尔有电轴左偏 ,并伴有T波倒置 ,某些病例可在其他导联 (V4)上出现ST段的抬高 ,而且绝大多数Brugada波并无对应导联的ST段下移改变 ,QT间期并不延长。ST段抬高的诊断标准是 ,V1～V3 导联上J点至…     

发热引起心电图Ⅰ型Brugada波1例

患者男,56岁。因发热就诊。心电图示不完全性右束支阻滞伴胸前V1～V3导联的ST段呈尖峰抬高。V1、V2导联T波倒置,TV3直立。记录部位提高2肋间时J点抬高更明显,特别在V2导联可达0.35mV,形成Ⅰ型Brugada波(图1A、B)。心脏电生理检查静滴心律平后,行S1S2S3300/600/210ms程序剌激,诱     

异常J波、Brugada综合征与特发性Brugada心电图征的临床与心电图特征

对比分析异常J波 2 1例、Brugada综合征 8例与特发性Brugada心电图征 11例的临床及心电学特点。结果 :①特发性异常J波在肢导联或 (和 )胸导联可见正向异常J波 [除aVR(部分患者aVL)外 ],其波幅较低而分布较广 ,一般V1～V2 导联不出现J波 ,若出现则JV1 ～V2R ,TV1 ～V2 (V3) 倒置或直立 ,前者常出现恶性快速性室性心律失常而发生晕厥或猝死 ,后者则无晕厥或猝死及恶性心律失常发作。结论 :异常J波和Brugada综合征及特发性Brugada心电图征是具有不同临床及心电学特点的临床实体。     

Brugada波与Brugada综合征的区别诊断

Brugada波是一种特殊的心电图形 ,表现为右束支阻滞、右胸导联 ST抬高和 T波倒置“三联征”。 Brugada波患者常突发恶性心律失常 ,称 Brugada综合征。Brugada综合征病情凶险 ,死亡率极高 ,国内李亦晗等曾报道 2例 [1 ] 。因此充分认识本病的意义 ,对 Brugada波与 Brugada综合征进行正确的区别诊断十分必要。1　临床资料　患者 ,男性 ,4 7岁。于 2 0 0 2 - 0 5 - 2 2 ,以外伤血气胸收入院。 0 6 - 0 4 T0 5∶ 0 0突发室上性心动过速 ,HR15 0 /min。静脉注射心律平后转为窦律。 6月 30日行 Holter检查 ,CM1导联见到间歇性右束支阻滞伴 …     

Brugada波1例

患者男,44岁。心慌气短,胸前不适月余就诊。查体血压120/80 mmHg,彩色多普勒心脏B超结果正常,血脂血糖在正常范围,心电图示:窦性心律、心率85次/分,QRS间期0·09s,Q-T间期0·34s,平均心电轴+52°,ST-T在正常范围,V1、V2导联呈RS型,ST段呈下斜型抬高,T波倒置,QRS波终末与抬高的ST段融合,呈右束支阻滞图型,心电图诊断:①窦性心律;②Brugada波。随访心电图未见变化,无心律失常发生。讨论国内有关书中提出Brugada波后,有关文章相继刊出。右胸导联ST段抬高,右束支传导阻滞和T波倒置称为心电图右胸导联3联征,亦即Brugada波的典型表现…     

Brugada波与Brugada综合征

Brugada综合征是一编码离子通道基因异常所致的家族性原发心电活动紊乱性疾病。自 1991年BrugadaP和BrugadaJ报告于临床以来 ,由于其右胸前导联特征性心电图改变和猝死病症 ,所以多年来一直是心血管病基础和临床研究的热点。 2 0 0 1年HurstJW将Brugada描述的V1～V3 导联特征性心电图改变称为“Brugada波”。本文仅对Brugada波的特点、鉴别和与Brugada综合征的关系等临床医师关注的具体问题简要讨论如下。一、Brugada波的心电图特点1、典型心电图表现Brugada波由抬高的ST段和“右束支阻滞”(RBBB)共同组成 ,典型者常伴倒置的T波 ,…     

心电图Brugada征与处理对策

Brugada综合征于1992年由西班牙Brugada兄弟首先报道。该综合征多见于东南亚地区无心脏结构异常的年轻男性，其发病与心脏钠通道基因SCN5A突变有关。患者有心室颤动发作，可致猝死。心电图表现为右束支传导阻滞和V1～V3导联ST段穹窿形或马鞍形抬高，T波倒置。有学者将以上心电图改变称为Brugada征。     

急性肺动脉栓塞的心电图演变

为探讨心电图在急性肺动脉栓塞 (简称肺栓塞 )诊断与对治疗效果评价中的作用 ,回顾性分析 18例急性肺栓塞患者入院时、溶栓后及治疗 2～ 4周后的心电图变化。研究显示 :①急性大块肺栓塞后即可出现sⅠqⅢ 及右束支阻滞的心电图表现 ;②TⅢ 及TV1 ～V3倒置往往在发病 1～ 2h后按一定的顺序相继出现 ,依次为TV1 →TV2 →TV3→TV4 ,倒置的深度TV1 →TV2 →TV3→TV4 ;经适当的治疗 ,随病情好转 ,上述导联倒置T波恢复的顺序则相反 ;③经溶栓或抗凝治疗后 ,下列心电图变化是病情缓解或肺动脉开通的征象 :a .窦性心动过速消失 ;b .Ⅰ和V5～V6导联的s波明显缩小甚至消失 ;c.V1～V3 (V4)导联T波倒置加深 ;d .右束支阻滞消失 ;e .TⅢ 、qⅢ 及rⅢ 的变化则呈双向性 ,当肺栓塞发病后数小时至 3天内即溶栓者溶栓后rⅢ 递减、qⅢ 进行性加深增宽、TⅢ 倒置进行性加深 ;反之 ,肺栓塞发病一周后进行溶栓者溶栓后qⅢ 明显缩小、TⅢ 由倒置很快变直立。结论 :急性肺栓塞的心电图变化呈一过性及多变性 ,动态观察心电图演变有助于诊断及对疗效的判断。     

Brugada波电交替及临床意义探讨

目的分析Brugada波的电交替现象。方法回顾性分析存在1型Brugada波且伴ST段和/或T波电交替现象的5例患者的心电图及临床特点。结果 5例患者均为男性,年龄18~50岁,入院时均存在1型Brugada波,并且分别在病因诊断确立或病情得到纠正过程中见到ST段和/或T波的电交替现象。ST段电交替可表现为抬高程度(高和低)的交替和抬高类型的(穹隆型和马鞍型)的交替,T波电交替表现为振幅(高和低)的交替和方向(双向和倒置)的交替。结论 Brugada波电交替现象可以发生于多种情况,同样具有多变性的特点。     

Appearance of right bundle branch block in electrocardiograms of patients with pulmonary embolism as a marker for obstruction of the main pulmonary trunk.

A number of changes occur in the electrocardiogram (ECG) of pulmonary embolism. This article deals with the diagnostic value of the newly emerged right bundle branch block (RBBB) as a manifestation of acute right ventricular overload. A certain correlation between the extent of obstruction of the pulmonary artery and the appearance of RBBB is established through dynamic monitoring of the ECG. Fifty cases of dissectionally proven pulmonary embolism are observed, in 20 of which massive trunk obstruction had taken place, and in the remaining 30 peripheral embolism in the pulmonary artery was established. With 80% of the trunk embolism patients (16 cases), a newly emerged RBBB was detected in their ECG, and with the remaining 20% (4 cases), ST-segment depression and T-wave inversion in leads V(1)-V(4) were observed as well as right axis deviation. S(1)Q(3)T(3) syndrome was detected among 60% (12 cases) of trunk embolism patients. In none of the peripheral embolism cases was RBBB in the ECG registered. Thus, its appearance on dynamic monitoring of the ECG of pulmonary embolism patients is a significant sign of the probability of massive obstruction of the main pulmonary trunk.     

Intravenous administration of class I antiarrhythmic drugs induced T wave alternans in a patient with Brugada syndrome

A 71-year-old man who experienced aborted sudden death was referred to our hospital. Coronary artery disease and cerebral accident were ruled out by conventional tests. The 12-lead ECG obtained at rest showed a right bundle branch block pattern and ST segment elevation in leads V1 to V3. Double ventricular extrastimuli at coupling intervals >180 msec induced ventricular fibrillation (VF) twice during electrophysiologic study. Intravenous administration of procainamide accentuated ST segment elevation in leads V1 to V3, and visible T wave alternans was induced in leads V2 and V3 at a dose of 450 mg. Initiation of T wave alternans was not associated with changes of the cardiac cycle or development of premature beats. When procainamide infusion was discontinued, T wave alternans disappeared before the elevated ST segment returned to the control level. Pilsicainide also accentuated ST segment elevation and induced similar T wave alternans in leads V2 and V3. Class I antiarrhythmic drug-related T wave alternans has been reported rarely in Brugada syndrome, but it may represent enhanced arrhythmogenicity of VF. We need to monitor closely and study the clinical implications of T wave alternans in Brugada syndrome.     

Brugada综合征和特发性J波的临床分析

目的：了解Brugada综合征和特发性J波的临床和心电图特点及其异同点,方法：对收集的10例Brugada综合征和8例特发性J波患者临床和心电图资料进行对比并结合文献。结果：两病有 相似的临床和心电图表现,但心电图表现仍有一定区别,Brugada综合征R’波大于R波,多见于V1－V3导联,伴ST段持续抬高,T波倒置,图形较恒定,特发性J波中J波小于R波,在Ⅱ,Ⅲ,aVF和V4－V6导联多见,无T波倒置,J波可因药物,运动等原因在短时间内明显改变。结论：Brugada综合征和特发性J波临床表现相似,可能有相同的发病机制,只是影响的部位不同,其区别主要在心电图表现。     

Electrocardiographic differentiation between acute coronary syndrome and acute pulmonary embolism associated with inverted T waves in precordial leads

Background Inverted T waves in precordial leads are often seen in patients with acute pulmonary embolism (APE) and acute coronary syndrome (ACS). The purpose of this study was to analyze the electrocardiogram (ECG) difference between APE and ACS related inverted T waves in precordial leads. Methods The ECG difference among 62 patients with APE and 125 patients with ACS related inverted T waves in precordial leads were compared. Results Compared with ACS, Patients with APE were more frequently associated with incomplete or complete RBBB or slurred S wave in lead V1, the sum of the depth of inverted T waves in leads V1 and V2 not less than in lead V3 and V4 (inverted TV1 + V2 ≥ inverted TV3 + V4), and inverted T waves in leads V1 and Ⅲ. Conclusions Complete or incomplete RBBB or slurred S wave in lead V1, inverted T waves in leads V1 and III, and inverted TV1 + V2 ≥ inverted TV3 + V4 are useful criteria for predicting APE.     

Brugada综合征相关基因SCN5A新突变位点的检测

目的 研究中国人Brugada综合征相关基因SCN5A突变情况。方法 利用多聚酶链反应及DNA测序对1个Brugada综合征家系SCN5A基因的全部28个外显子进行基因检测。结果 在国内外已知突变点均无突变，发现1个新的错义突变位点(A5471G)，其相应的氨基酸改变为N1774S。结论 在中国人Brugada综合征患者的SCN5A基因上发现1个新的突变位点。     

QT Interval Prolongation with Global T‐Wave Inversion: A Novel ECG Finding in Acute Pulmonary Embolism

Objective: The purpose of this study was to report a novel electrocardiographic (ECG) phenomenon in acute pulmonary embolism characterized by QT interval prolongation with global T‐wave inversion. Methods: Among a total of 140 study patients with a confirmed diagnosis of acute pulmonary embolism, patients who fulfilled the inclusion criteria for QT interval prolongation with global T‐wave inversion were examined. Each of these patients had undergone a detailed clinical evaluation including testing for myocardial injury and echocardiography. Results: QT interval prolongation with global T‐wave inversion was found in five patients (age 51–68 years) with acute pulmonary embolism. Four were women. Acute pulmonary embolism was diagnosed by ventilation‐perfusion scan in three patients and by spiral computed tomography in other two patients. None of the patients had any right or left ventricular regional wall motion abnormalities on echocardiography. All patients had changes characteristic of hemodynamically significant pulmonary embolism, including right ventricular stunning or hypokinesis and dilatation in five patients with paradoxical septal motion in four. Acute coronary syndrome was ruled out in each patient by clinical evaluation, serial ECGs and cardiac markers, and lack of regional wall motion abnormalities on echocardiography. Prolongation of QT intervals (QTc 456–521 ms) with global T‐wave inversion was noted on presentation. The ECG changes gradually resolved in 1 week in all patients with appropriate treatment of acute pulmonary embolism. One patient died. None of the patients developed torsade de pointes. Conclusions: Acute pulmonary embolism may occasionally result in reversible QT interval prolongation with deep T‐wave inversion, and, thus should be considered among the acquired causes of the long QT syndrome.