非Q波型心肌梗死的心电图诊断

急性Q波心肌梗死的心电图特点是异常Q波，ST段呈弓背型台高与直立的T波形成单相曲线；急性非Q波性心肌梗死的心电图仅显示缺血性ST段下降(≥0．1mv)，T波对称性倒置持续48小时以上或只有R波的异常改变，但不出现病理性Q波，此型占心肌梗死的20-40％，为不导致遗漏诊断，将多年工作中遇到的几种常见类型介绍给同行们。     

无Q波型心肌梗死50例心电图分析与鉴别

无Q波型心肌梗死(NQMI)的心电图上始终不出现特征性的Q波，仅出现的ST段及T波改变又缺乏特征性，易被误诊。为探讨NQMI的心电图变化，掌握与类似心电图的鉴别．现将我院所收治的50例NQMI的心电图分析如下。     

不稳定型心绞痛和无Q波心肌梗死的诊治

１引言不稳定型心绞痛和无Q波心肌梗死是冠状动脉粥样硬化性心脏病常见和危险的急性表现。２０世纪９０年代以来欧美国家数次制订和修改了针对不稳定型心绞痛和无Q波心肌梗死的诊疗指南。我国去年由中华医学会心血管分会首次制定了不稳定型心绞痛的诊治建议。本文就不稳定型心绞痛和无Q波心肌梗死的诊治现状作一讨论。２病理生理不稳定型心绞痛和无Q波心肌梗死的病理基础是冠状动脉粥样硬化斑块。疾病发生并非与斑块大小有关，而由斑块不稳定所致。表现为斑块脂质核心饱满，大量炎性细胞浸润，巨噬细胞向纤维帽移行，释放蛋白分解酶，溶解…     

无Q波心肌梗塞的诊断与治疗

<正> 多年来,临床上一直把心肌梗塞分为透壁性和非透壁性(或内膜下)心肌梗塞两大类,其区别是心电图(BCG)是否出现病理性Q波。但许多学者通过大量动物试验和病理解剖研究发现:有明确Q波的前壁和下壁AMI其梗塞深度可只局限于心内膜下。Coor等通过实验也证实梗塞仅累及左室厚度的1/2便可引起Q波。Durrer等在狗的心外膜进行测定发现;即使梗塞直径<1cm,深度仅达室壁厚度的1/4,也可在EOG上记录到Q波。ECG上出现病理     

急性Q波心肌梗死的诊治

1 引言 根据心电图表现,以前将急性心肌梗死(AMI)临床分为Q波心肌梗死及无Q波心肌梗死.前者病理上常认为是穿壁性心肌梗死,后者则常认为是心内膜下心肌梗死,但临床与病理不一定完全符合.近年来AMI病理生理学的重要进展,使人们重新认识了急性冠状动脉综合征,其中包括不稳定心绞痛、无Q波心肌梗死及Q波心肌梗死.     

急性无Q波心肌梗死与左室重构

目的　探讨急性无Q波心肌梗死 (non Q wavemyocardialinfarction ,NQMI)左室重构的特点。 方法　应用二维超声心动图检查 2 1例急性NQMI及 3 6例急性Q波心肌梗死 (Q wavemyocardialinfarction ,QMI)患者左室舒张末期容积指数 (leftventricularend diastolicvolumeindex ,LVEDVI)。检查时间为梗死后 1周内及 4周时 ,NQMI患者在梗死后 14周再检查 1次。比较前后LVEDVI变化。结果　QMI患者梗死早期 ( 4周内 )即出现LVEDVI明显增加 [( 60± 5 )ml/m2 比 ( 82± 6)ml/m2 ,t =2 .81,P <0 .0 0 1],NQMI患者LVEDVI并无改变。然而 ,有 3例NQMI患者在梗死后 14周时LVEDVI明显增加 ,此 3例患者均伴有左心功能不全。结论　NQMI患者也会出现左心室重构 ,应采取相应的预防措施     

异常Q波的鉴别诊断

异常Ｑ波的鉴别诊断心电图上异常Ｑ波的出现是诊断心肌梗塞的重要依据。但是一些非梗塞性疾患，心电图上也常出现异常波。如：心肌病、心肌炎性病变，左心室肥厚，左前分枝传导阻滞、左束枝传导阻滞，症候群、慢性阻塞性肺气肿，自发性气胸，肺栓塞、颅内出血，以及心脏外...     

老年人非Q波心肌梗死的临床研究

目的：探讨60岁以上老年人非Q波心肌梗死（NQMI）的临床特点。方法：回顾性分析60岁以上老年人心肌梗死9MI）136例，其中NQMI组45例，Q波心肌梗死（QMI）组91例，将其临床资料进行比较分析。结果：（1）NQMI组室速或室颤、泵衰竭和心源性休克（6．67％、8．89％、6．67％）显著低于QMI组（14．3％、20．9％、18．7％），P＜0．05。（2）NQMI组梗死后心绞痛和再梗死率分别为37．8％和15．6％高于QMI组（18．7％和8．79％），P＜0．05。（3）NQMI组心绞痛（91．1％）高于QMI组（71．4％），P＜0．05。（4）NQMI住院病死率为6．69％，低于QMI组（16．5％），P＜0．05）；而1a内心脏事件发生率NQMI组为33．3％，高于QMI组15．4％，P＜0．05。（5）NQMI组并发糖尿病占24．4％，高于QMI组（12．1％），P＜0．05。（6）2组间高血压、高血脂、性别、Zung评分差异无显著性。结论：60岁以上老年人虽然NQMI的高血压、高血脂、性别、Zung评分与QMI相似，但是发病前心绞痛、梗死后心绞痛、再梗死者较QMI者多，其并发症和住院病死率较QMI低；远期心脏事件发生率较QMI高。     

院前急救患者心率对无Q波心肌梗死估测的探讨

无Ｑ波型心肌梗死（ＮＱＡＭＩ）占全部急性心肌梗死的２０％～３８％〔１〕,其心电图改变可分为：ＳＴ段下移型、ＳＴ段抬高型和Ｔ波倒置型。其中,ＳＴ段下移型占ＮＱＡＭＩ的５０％以上〔２〕,预后较差〔３〕。ＳＴ段广泛明显下移是ＳＴ段下移型ＮＱＡＭＩ的特征心电...     

无Q波心肌梗塞研究进展

多年来,临床上一直将急性心肌梗塞(AMI)按心电图有无病理性Q波分为二种类型:透壁性MI和非透壁性MI或心内膜下MI.近年来研究证明,非透壁性MI有时可有病理性Q波出现,相反,透壁性MI有时则不出现Q波.无Q波型MI(NQMI)与Q波型MI(QMI).无论在病理生理、诊断标准方面,还是在治疗和预后等方面均有重要区别.     

心肌损伤标志物在非Q波型急性心肌梗死早期诊断中的应用

目的探讨心肌损伤标志物在非Q波型急性心肌梗死（AMI）早期诊断中的应用,减少非Q波型AMI误诊的机会。方法通过单克隆金标志双抗免疫渗滤快速分析法,动态观测心肌标志物在非Q波型AMI时的敏感性、特异性、漏诊率及诊断符合率。结果心肌肌钙蛋白I（cTnI）、肌红蛋白（Myo）、肌酸激酶-同工酶质量（CK-MB mass）对非Q波型AMI的相对敏感性为38．3％～85．1％,诊断符合率为62．1％～82．8％,均随时间增加逐渐增高;相对特异性为75．0％～100％,漏诊率为14．9％～61．7％,均随时间增加降低;心肌肌钙蛋白T（cTnT）、cTnI在不同时间均优于CK-MB mass,Myo相对敏感性在6h后迅速从85．1％下降至44．7％、12．8％,漏诊率在6h只有14．9％。结论cTnT、cTnI、Myo、CK-MBmass对非Q波型AMI的早期、快速诊断具有一定价值,其临床应用将减少非Q波型AMI误诊的机会。     

Hypo- and hyper-diagnostics of non-Q wave myocardial infarction during prehospitalization period

AIM: To estimate prevalence of hypo- and hyperdiagnosis of non-Q myocardial infarction (MI). MATERIAL AND METHODS: The results of prehospital diagnosis of MI in 1500 patients examined in 1992-1996 are reported. Estimation was conducted in different clinico-electrocardiographic and clinico-demographic groups. RESULTS: Non-Q MI occurred in 74.1% cases. Non-Q and Q MI ran atypically in 33.0 and 12.9% patients, respectively (p < 0.01). Hypo- and hyperdiagnosis of Q and non-Q MI was made in 3.8 and 2.1, 17.3 and 35.9%, respectively. In typical and atypical MI hypodiagnosis was made in 13.4 and 21.2% cases, respectively, while hyperdiagnosis was observed in 19.9 and 45.8% (p < 0.01). The MI hyper/hypodiagnosis coefficient was highest in patients under 45 years of age (2.6%) and in repeated MI (2.5). CONCLUSION: Misdiagnosis of non-Q MI is most essential in epidemiology of missed diagnosis in this disease. High incidence of hypo- and hyperdiagnosis in non-Q MI as well as atypical MI are explained by objective difficulty of prehospital diagnosis in these MI variants and high MI alertness of the doctors in low significance of the disease.     

The role of angioplasty for non-Q wave myocardial infarction: The impact of diabetes on outcomes

Understanding of the mechanisms, outcomes and treatment of non-Q wave myocardial infarction (NQMI) has evolved. Coexisting diabetes poses additional challenges. We studied baseline characteristics, in-hospital and one-year outcomes for NQMI patients having percutaneous transluminal angioplasty.     

糖尿病并肌梗塞延误诊治一例

女，59岁。因反复口渴、多饮、多尿、消瘦8年，加重伴下肢水肿1个月入院。8年前不明原因出现口渴、多饮、多尿、消瘦，查血糖高，诊断为糖尿病，经降糖药物治疗，上述症状好转。但因治疗不正规，病情常反复加重。1个月前症状再次加重并伴下肢水肿、排尿困难，收入院。查体：体温36．8℃，脉搏90／min，呼吸     

Delayed diagnosis of post-traumatic acute myocardial infarction complicated by congestive heart failure

A 53-year-old man experienced persistent chest pain followed by slight shortness of breath after being hit in the chest by a stranger. Chest X-ray study showed no rib fractures but electrocardiography indicated acute anterior wall myocardial infarction. Echocardiography revealed akinesia in both the interventricular septum and anterior left ventricular wall. Emergency cardiac catheterization demonstrated total occlusion of the proximal left anterior descending coronary artery, 9 h after the event. He was successfully treated with coronary angioplasty and stenting procedures. However, poor left ventricular function was observed 3 months after the event despite medications. We conclude that evaluation for possible myocardial injury should be considered soon after blunt chest trauma for early treatment to improve prognosis.     

Prognostic value of disturbed local contractility in stress-echocardiography performed in patients with non-Q myocardial infarction

Prognostic value of viable dysfunctioning myocardium after non-Q infarction diagnosed at stress-echocardiography with low doses of dobutamine was clarified as a result of a one-year prospective study of 36 patients. Viable myocardium was found in 38.9% of the cases of non-Q myocardial infarction. Any stress-induced dynamics of local contractility correlates with high risk of repeat acute coronary events within the year after non-Q myocardial infarction.     

Electrocardiographic diagnosis of acute myocardial infarction

The widely recognized benefits of early diagnosis and treatment of acute myocardial infarction (AMI) have only emphasized the importance of emergency physician (EP) competence in electrocardiographic interpretation. As such, the EP must be an expert in the interpretation of the electrocardiogram (ECG) in the emergency department chest pain center patient. The ECG is a powerful clinical tool used in the evaluation of patients, assisting in making the diagnosis of AMI and other syndromes, selecting appropriate therapies (including thrombolysis and primary angioplasty), securing the location of an adequate inpatient disposition, and predicting the risk of cardiovascular complications and death. This article will discuss the appropriate uses of the ECG in the patient with possible or confirmed AMI and review the typical electrocardiographic findings of AMI, diagnostically confounding patterns, mimickers of infarction, and new techniques.     

急性心肌梗死后延迟冠状动脉介入术的临床分析

目的　探讨急性心肌梗死(AMI)后延迟经皮冠状动脉腔内成形术及支架术治疗的临床疗效。方法　将88例患者分为经皮冠状动脉介入治疗(PCI)和非PCI组,PCI组于发病后平均13d行PCI术。随访两组患者的心脏事件发生率。结果　与非PCI组相比,PCI组患者在不稳定型心绞痛发作,左室射血分数的提高及复合终点事件方面差异有显著性。结论　AMI后延迟PCI可减少患者的心脏事件发生。     

急性心肌梗死的延迟性经皮冠状动脉介入治疗的疗效探讨

目的通过对急性心肌梗死(acutemyocardialinfarction,AMI)急性期后行延迟性经皮冠状动脉介入治疗(percutaneouscoronaryintervention,PCI),观察其疗效,安全性和预后。方法53例AMI患者,入院后按AMI诊断和治疗指南犤1犦作常规治疗(包括溶栓治疗),在发病5～15d后为患者作PCL结果共干预梗死相关动脉(infarctrelatedarteries,IRA)68支68处病变,经皮腔内冠状动脉成形术,(percutaneoustransluminalcoronaryangioplastyPTCA)加支架64例,直接植入支架4例,共植入支架68枚。术前IRA前向血流心肌梗死溶栓治疗试验(thrombolysisinmyocardialinfarctiontrial,TIMI)分级0～2级,术后均达到TIMI3级。住院期间无一例死亡、再发心肌梗死、梗塞后心绞痛、再次血管重建。出院后随访5～48个月,再发心肌梗死1例(1.9%),死亡1例(术后5个月,1.9%)不稳定型心绞痛3例(6～14个月,5.7%)。再次PCI2例,冠状动脉旁路移植术(coronaryarterybypassgraft,CABG)1例,再次血管重建率5.7%。术后6～48个月无死亡。再次住院7人次(13.2%)。结论急性期后延迟性PCI能明显改善AMI患者的近期和远期预后,提高生活质量。且相对安全,操作风险少。