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急性前壁心肌梗死时心电图对预测冠状动脉前降支闭塞位置的作用 总被引:1,自引:0,他引:1
目的:探讨心电图对准确预测前壁急性心肌梗死(AMI)时冠状动脉前降支(LAD)闭塞位置的作用。方法:对94例前壁AMI患者的心电图和冠状动脉造影资料进行分析。结果:①前间隔AMI患者前降支闭塞位置大都发生在第1间隔支和第1对角支开口远端,且单支病变多见。②前壁和前壁伴高侧壁AMI患者前降支闭塞位置发生在第1间隔支与第1对角支开口近端的发生率分别为289%与263%和550%与475%。前壁伴高侧壁AMI患者若以大的对角支作为解剖分界进行分析,则800%其血管闭塞位置在大的对角支发出前,若以aVL导联ST段抬高>1mm,Ⅲ、aVF导联ST压低>1mm为标准,预测血管闭塞位置在第1对角支开口近端和大对角支开口近端的发生率分别为692%和923%。③前壁伴下壁AMI者前降支闭塞位置均发生在第1间隔支开口远端。结论:心电图对前壁AMI时前降支的闭塞位置有重要的预测价值 相似文献
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Po‐Chao Hsu Tsung‐Hsien Lin Ho‐Ming Su Wen‐Chol Voon Wen‐Ter Lai Sheng‐Hsiung Sheu 《Annals of noninvasive electrocardiology》2010,15(1):90-93
Combined anterior and inferior ST elevation due to occlusion of wrapped left anterior descending artery (LAD) is well reported in the literature. However, there is rare literature mentioned about inferolateral ST elevation in this patient group. Herein, we report a case of acute proximal wrapped LAD occlusion with initial electrocardiographic sign of inferolateral ST elevation. The most likely mechanism of this electrocardiographic finding might be related to old anteroseptal myocardial infarction, combination with other coronary abnormality, such as chronic total occlusion of left circumflex artery that caused larger injury current in inferolateral than anteroseptal myocardium, and made anteroseptal leads reveal isoelectric pattern. Ann Noninvasive Electrocardiol 2010;15(1):90–93 相似文献
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目的:分析慢性完全闭塞(CTO)病变对接受急诊介入治疗的急性心肌梗死(AMI)患者远期预后的影响。方法:分析自2013年1月至2014年9月间纳入中国急性心肌梗死(CAMI)注册登记研究的接受急诊介入治疗的14176例AMI患者,根据冠状动脉造影的结果,将患者分为AMI合并CTO病变组(n=1235)和AMI不合并CTO病变组(n=12941)。随访2年,比较两组的临床预后,主要研究终点为死亡率,次要研究终点为包括心原性死亡、脑卒中、心力衰竭再入院、再次血运重建等的主要不良心血管事件。结果:合并CTO病变的AMI患者占8.7%(1235/14176)。随访2年,AMI合并CTO病变组的患者全因死亡率(9.9%vs.5.4%)和心原性死亡率(5.0%vs.2.6%)明显高于AMI不合并CTO病变组患者(P均<0.01)。单因素分析显示,CTO病变增加AMI患者死亡(HR=1.44,95%CI:1.02~2.03,P=0.04)和再次血运重建(HR=2.14,95%CI:1.55~2.96,P<0.01)风险。多因素回归分析显示,高龄(HR=1.07,95%CI:1.05~1.09)和就诊时存在心力衰竭(HR=2.05,95%CI:1.36~3.09)与患者2年死亡的不良预后明显相关(P均<0.01),而CTO病变不是2年死亡的独立危险因素(HR=1.33,95%CI:0.93~1.90,P=0.11)。结论:合并CTO病变的AMI患者的远期死亡率和心原性死亡率明显高于不合并CTO病变的患者。高龄和就诊时存在心力衰竭是远期死亡的独立危险因素,而CTO病变并不是远期死亡的独立危险因素。 相似文献
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Tchavdar N. Shalganov MD 《Clinical cardiology》2009,32(11):E49-E51
We report on a case of an adult male patient with previously unknown coronary anomaly and acute myocardial infarction in the territory of the left anterior descending artery (LAD). The coronary angiography showed a single coronary artery with intertruncal course, arising from the right coronary sinus, and thrombotic occlusion of the LAD. Successful transradial percutaneous coronary intervention was done with implantation of an intracoronary stent in the occluded artery. The postprocedural course was complicated by ventricular tachycardia, congestive heart failure, and mild transient renal failure. In conclusion, transradial percutaneous coronary intervention is safe and feasible in rare coronary artery anomalies even in an emergent setting. The finding of an anomalous coronary artery should not be a reason to decline performing coronary intervention. Copyright © 2009 Wiley Periodicals, Inc. 相似文献
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Miguel Fiol MD PhD Andrés Carrillo MD Iwona Cygankiewicz MD PhD Julio Velasco MD Maria Riera MD Antoni Bayés‐Genis MD PhD Alfredo Gómez MD PhD Vicente Peral MD PhD Armando Bethencourt MD PhD diego Goldwasser MD Fredis Molina MD Antoni Bayés de Luna MD PhD FESH FACC 《Clinical cardiology》2009,32(11):E1-E6
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Prevalence of Early Left Ventricular Thrombus after Primary Coronary Intervention for Acute Myocardial Infarction 总被引:1,自引:0,他引:1
The prevalence of left ventricular (LV) thrombus after acute myocardial infarction (AMI) has been reported high at 20–60%. Current reperfusion therapies such as thrombolysis have shown a trend toward reducing the incidence of LV thrombosis. However, the prevalence of LV thrombus after primary percutaneous coronary intervention (PCI) for AMI has not been systematically studied. At Massachusetts General Hospital 71 consecutive patients who underwent primary PCI for acute ST elevation MI were reviewed for the prevalence of LV thrombus evaluated by echocardiography. Echocardiography was performed within 5 days of infarction. PCI was successful in all patients. The time delay from symptom onset to intervention was 191 minutes. Thrombolysis in Myocardiol Infarction (TIMI) grade 3 flow was achieved in more than 80% of cases. Only 3 patients (4%) had echocardiographic evidence of LV thrombus. All 3 patients had anterior infarctions. The incidence among patients with anterior MI was 10% (3 of 30 patients). The prevalence of LV thrombus in patients treated with primary PCI for AMI is low (4%). 相似文献
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Catheter Ablation in the Right Ventricular Outflow Tract Associated With Occlusion of Left Anterior Descending Coronary Artery 下载免费PDF全文
DANIEL BENHAYON M.D. EYAL NOF M.D. WILLIAM W. CHIK M.D. Ph.D. FRANCIS MARCHLINSKI M.D. 《Journal of cardiovascular electrophysiology》2017,28(3):347-350
Major vessel injury during right ventricular outflow tract ablation is not something widely recognized, and routine evaluation of the left anterior descending (LAD) artery location in relation to the septal right ventricle is not routinely performed. In the present article, we report a case of acute LAD occlusion after right ventricular outflow tract ablation and then illustrate the intimately close relationship of the LAD artery to the anterior septal site of the RVOT (approximately 2–3 cm under the pulmonic valve), using a combination of intracardiac echocardiography and 3‐dimensional electroanatomical mapping recorded during a second case, in order to specifically point to the area at risk. 相似文献
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急性心肌梗死经皮冠状动脉介入治疗研究进展 总被引:2,自引:0,他引:2
急性心肌梗死的治疗主要涉及药物和介入治疗两个方面。及时有效的经皮冠状动脉介入治疗能迅速开通阻塞的冠状动脉、挽救濒死心肌,降低急性心肌梗死病人的病死率和病残率。现就有关急性心肌梗死的经皮冠状动脉介入治疗研究进展作一综述。 相似文献
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Objectives To assess the effect of delayed opening the infarct - related artery(IRA) by percutanous coronary intervention (PCI) on the late phase left ventricular function after acute anterior myocardial infarction. Methods 64 patients with initial Q -wave anterior myocardial infarction and the infarct- related arteries were total occluded conformed by angiogram at 2 to 14 days after onset were divided into successful PCI group and control group (not receiving PCI or the IRA not re - opened). 2 - DE was performed at early phase ( about 3 weeks) , 2 and 6months after onset of AMI respectively to detect the left ventricular function and left ventricular wall motion abnormality (VWMA). The total congestive heart failure events were recorded during 6 months follow-up. Results VWMA scores, left ventricular ejection fraction (LVEF), left ventricular end - diastolic and end-systolic volume indices (LVEDVI and LVDSVI)were similar in 2 groups at early phase and 2 months.There were no differences between early phase and 2months in each group too. VWMA scores and LVEF did not changed at 6 months in each group compared with the early phase and 2 months (P > 0.05 ). But LVEDVI and LVESVI were significantly smaller in the successful PCI group than in the control group (P <0.01,P < 0. 05 ). The congestive heart failure events were taken place in 19% of patients in control group compared with 2% in successful PCI group ( P > 0.05 ).Conclusions Although the infarct size does not changed, delayed opening the IRA has beneficial effect to the late phase left ventricular dilatation after acute anterior myocardial infarction. 相似文献
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易化的经皮冠脉介入治疗——急性心肌梗死治疗新策略 总被引:5,自引:0,他引:5
急性心肌梗死再灌注治疗的方法主要包括溶栓和紧急经皮冠脉介入治疗,其中溶栓治疗简单易行,但再灌注不充分,并且再闭塞率高;而直接经皮冠脉介入治疗,可以恢复心外膜血管的血流,血管的开通率高,但是只有在有条件的医院才能进行,而对于急性心肌梗死来讲,血管开通的时间是最重要的,因此,人们试图通过将溶栓治疗和经皮冠脉介入治疗联合应用来发挥各自的优势,尽量减少缺陷来尽快恢复心脏血流供给,也就是采用易化经皮冠脉介入治疗的方法来治疗急性ST段抬高心肌梗死,从而获得梗死相关动脉更早的开通和更高的开通率。 相似文献
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急性心肌梗死后心脏收缩和舒张功能受损,直接影响到患者的预后.既往对心室收缩功能研究较多,对急性心肌梗死时左心房结构及功能变化的研究相对较少,而左心房结构及功能的变化又直接影响到心室的舒张功能及患者的预后.现就急性心肌梗死时左心房结构及功能的变化及其意义做一总结. 相似文献