急性下壁心肌梗死伴胸前导联ST段压低的临床意义

近几年来,下壁急性心肌梗死(AMI)伴胸前导联ST段压低已经逐渐引起临床的重视。多数研究认为,根据心电图病理性Q波改变所确定的MI范围与尸体解剖所示的确切范围之间的相关性并不高,故有必要探讨反映梗死面积的其他心电图指标。国外研究认为,下壁AMI伴发胸前导联ST段压低者梗     

急性下壁心肌梗死伴有胸前导联ST段压低的临床意义

目的 分析急性下壁心肌梗死（acute inferior myocardial infarction,AIMI）伴有胸前导联ST段压低的冠状动脉病变特点及临床意义。方法 回顾分析2006年8月～2007年8月住院的AIMI患者91例。按胸前导联ST段是否压低将患者分为4组:胸前导联ST段无压低组（n=27）;胸前导联仅V1～4 ST段压低组（n=26）;胸前导联仅V5～6 ST段压低组（n=12）;广泛胸前导联ST段压低组（n=26）。结果 AIMI伴有胸前导联V1～4 ST段压低与冠状动脉多支病变呈负相关,ORⅢ=0.38,无统计学意义;AIMI伴有胸前导联V1～6 ST段压低与冠状动脉多支病变呈正相关,ORⅣ=5.25,P<0.01,有显著统计学意义。胸前导联V1～6 ST段压低组与其他组相比较,左室射血分数（LVEF）低,差异显著（P<0.05）;该组前降支病变率高（73.1%）,但与其他3组相比无统计学差异。结论 AIMI伴有胸前导联V1～6 ST段压低提示多支病变,且心功能不全发生率高。     

115例急性下壁心肌梗死者胸前导联ST段变化规律探讨

下壁急性心肌梗死 (ＡＭＩ)心电图胸前导联ＳＴ段下移 ,已被广大心电和临床工作者认识 ,并在诊断中具有重要意义。同时也发现 ,并非所有下壁ＡＭＩ胸前导联ＳＴ段均有下移且下移程度亦有很大差别。1　资料与方法1 1　对象　 1993年 8月～ 2 0 0 1年 9月收治 ,根据ＷＨＯ标准确诊的下壁ＡＭＩ,同时有前间壁、前壁、前侧壁、广泛前壁ＡＭＩ,室内传导阻滞及早期复极综合征者除外 ,共 115例。男 6 9例、女 4 6例 ,年龄35～ 90 (6 6 6 3± 11 0 1)岁。1 2　方法　依有否右室壁、后壁ＡＭＩ分为 :单纯ＡＭＩ 2 2例 ,男 11例、女 11例 ;下壁、后壁…     

急性下壁心肌梗死伴胸前导联ST段压低患者的临床观察

通过对50例急性下壁心肌梗死伴胸前导联ST段压低患者与50例不伴胸前导联ST段改变急性下壁心肌梗死患者的临床对照观察，探讨其预后结果报告如下。     

急性下壁心肌梗死胸前导联ST段下移的临床意义

目的 探讨下壁急性心肌梗死时胸前导联心电图前壁ST段下移的意义。方法 对60例急性下壁心肌梗死病人的早期心电图及入院后3周内冠状动脉造影和心肌酶检查结果对照分析。结果 胸前导联ST段下移者41例(68%),多支病变39例,单支病变2例,胸导联ST段无下移者19例,多支病变4例,单支病变15例(P<0.01),而且前者有较高的CK峰值(P相似文献   

急性下壁心肌梗死心电图胸前导联V1-3 ST段抬高的临床意义

目的 探讨急性下壁心肌梗死患者心电图胸前导联ST段抬高与冠状动脉造影所示冠状动脉病变的关系及其临床意义.方法 187例急性下壁心肌梗死患者,按入院时18导心电图胸前导联ST段改变分为2组,ST段抬高组（16例）和非ST段压低组（171例）.所有患者均行冠状动脉造影术,病变适合行经皮腔冠状动脉成型术并检测B型钠尿肽（BNP）.结果 急性下壁心肌梗死伴胸前导联ST段抬高时多为右冠状动脉近段闭塞,尤其是圆锥支闭塞（P＜0.01）,且伴有右心功能不全和血流动力学障碍,与下壁右室心梗相比BNP差异有统计学意义（P＜0.01）.结论 急性下壁心肌梗死合并胸前导联ST抬高表明为右冠状动脉近段或开口闭塞且多伴右室心肌梗死和心功能不全.     

老年急性下壁心肌梗死胸前导联ST段压低的临床意义

急性下壁心肌梗死胸前导联ST段压低的临床意义及其发生机制尚未完全阐明。本文回顾分析了我院88例急性下壁心肌梗死患者的临床资料，旨在进一步探讨胸前导联ST段压低在急性下壁心肌梗死的临床意义以及ST段压低的可能机制。     

急性下壁心肌梗死伴胸前导联ST段显著压低1例

患者女性,67岁。患高血压病20年,冠心病5年。因心前区不适于2005年11月17日来我院就诊。查心电图（图略）示：心房颤动。2005年11月21日因心前区压榨样疼痛,又查心电图（图1A）示：STⅡ,Ⅲ,aVF抬高0．6～0．8mV,与QRS波融合成单向曲线。STI,aVL、V1-V6压低0．2～0．6mV。心电图诊断：心房颤动（Af）,下壁急性心肌梗死（AMI）伴胸前及侧壁导联ST段明显压低。     

急性下壁心肌梗死伴胸前导联ST段压低患者的临床预后分析

本文通过对38例急性下壁心肌梗死伴胸前导联ST段压低患者和35例不伴有胸前导联ST段改变的患者对比研究,观察两组在发病后4周内的心力衰竭、心源性休克、严重心律失常和病死率。1对象和方法1.1对象本院1993年3月至2004年5月收治的73例有Q波急性下壁心肌梗死患者,根据有无胸前导联ST段的压低分为两组:ST段压低组38(男28,女10)例,年龄40~89岁,其中伴V1~3ST段压低者13例,伴V4~6ST段压低者12例,伴V1-6ST段压低者13例。不伴胸前导联ST段改变组35(男27,女8)例,年龄42~82岁。2组性别、年龄、发病至入院时间及高血压、高血脂、糖尿病史等方面…     

急性下壁心肌梗死伴左胸导联ST段压低的临床意义

的　探讨急性下壁心肌梗死伴胸导联 ST段压低的临床意义。方法　选择收住院并行冠状动脉造影术的首发急性下壁心肌梗死患者 88例 ,按照胸导联有无 ST段下移分为不伴胸导联 ST段压低组 45例 ( ST段无压低或 ST段压低 <0 .1m V)及伴胸导联 ST段压低组 43例 ( ST段压低≥ 0 .1m V)。结果　伴胸导联 ST段压低组合并心力衰竭、严重心律失常、低血压及住院病死率较不伴胸导联 ST段压低组明显增高 ,冠状动脉造影显示左前降支病变及多支病变者显著增多。结论　急性下壁心肌梗死伴胸导联 ST段压低者其临床合并症多 ,预后差 ,冠状动脉多支病变及合并左前降支病变者显著增多 ,临床上应高度重视。     

胸前导联ST段压低范围和幅度在急性下壁心肌梗塞的意义

目的 :评价胸前导联 ST段压低对急性下壁心肌梗塞的临床意义及探讨其可能发生机理。　　方法 :回顾分析了 1992年～ 1997年期间首次住院诊断急性下壁心肌梗塞患者 183例。将患者分为 4组 :无胸前导联ST段压低组 ( 组 ,n=5 6 ) ;胸前导联 ST段 V1～ 3压低组 ( 组 ,n=31) ;胸前导联 ST段 V4～ 6 压低组 ( 组 ,n=2 3) ;胸前导联 ST段 V1～ 6 压低组 ( 组 ,n=73)。资料分析包括心电图、心肌酶谱、左心室和冠状动脉造影及心肌梗塞的并发症和病死率。　　结果 :胸前导联 ST段压低患者比无胸前导联 ST段压低患者存在较大梗塞范围 ,心肌梗塞并发症和住院病死率较高。广泛 ST段压低时更显著 ,其心律失常、心功能不全发生率和住院病死率分别为 45 .0 %、12 .3% (P<0 .0 5 )和 8.2 %(P<0 .0 1)。胸前导联 ST段广泛压低总和≥ 0 .8m V显示预后更差 ,住院病死率 9.4% ,同 ST段压低 <0 .2 m V比差异显著 (P<0 .0 5 )。 组和 组存在左前降支病变或合并多支冠状动脉病变明显高于 组 ,有统计学差异。　　结论 :胸前导联 ST段压低分布范围和压低幅度对急性下壁心肌梗塞患者的预后判断和危险分层有一定价值。可能提示心肌梗塞范围较大 ,或同时存在前降支病变和多支冠状动脉病变。     

急性前壁心肌梗死患者aVR导联ST段变化的临床意义

目的探讨急性前壁心肌梗死患者aVR导联ST段变化的临床意义。方法首次急性前壁心肌梗死患者75例,均经再灌注治疗及冠状动脉造影,依据心电图aVR导联ST段变化将病例分为抬高组、无偏移组和下移组。结果前降支再灌注TIMI分级0~1级在ST段抬高组、无偏移组、下移组分别为15例(78.9%)、31例(91.2%)、21例(95.5%),后两组与ST段抬高组比较有显著差异(P<0.05)。相对2~3级血流也类似情况,ST段抬高组与后两组比较有显著差异(P<0.01),犯罪血管为左主干病变的ST段抬高组、无偏移组、下移组分别为4例(21.1%)、1例(2.9%)、3例(13.6%),有显著差异(P<0.01);病变范围为前降支近端至S1,病变范围为前降支近端至D1,三组无明显差异,多支病变和侧支循环形成2级以上ST段抬高组与无偏移组,下移组与无偏移组均有显著差异(P<0.05);早期临床情况显示ST段抬高组和ST段下移组的血清BNP和cTnI明显高ST段无偏移组(P<0.05);ST段抬高组和下移组行CABG和IABP应用明显高于无偏移组(P<0.01),而左室射血分数(LVEF)无明显差异(P>0.05)。结论急性前壁心肌梗死患者如果aVR导联ST段抬高或下移可能提示有严重的左主干病变,左前降支病变或严重的多支病变,且有大面积的心肌梗死,心肌收缩功能损害明显,应用IABP或急诊CABG比率增高     

急性心肌梗死对应导联ST段下移的研究进展

急性心肌梗死患者心电图可出现ST段抬高 ,而在这些ST段抬高的患者中可同时出现梗死对应导联ST段下移。国内外进行了大量的临床和基础研究 ,认为对应导联ST段下移有助于急性心肌梗死的早期诊断 ,帮助判断冠状动脉阻塞位点和分析危险程度 ;镜象变化、远端缺血是其产生的主要原因。本文对急性心肌梗死对应导联ST段下移的临床意义及发生机制进行综述。     

非急性心肌梗死ST段抬高的临床意义

心电图ST段抬高主要见于急性心肌梗死,但心电图ST段抬高还可以在其它情况出现。本综述的目的是描述其他心电图上类似心肌梗死的ST段抬高的各种情况,找出与之区分的线索。     

急性心肌梗死再灌注治疗后ST段回落的研究进展

ST段回落的分析是急性心肌梗死再灌注疗效的评价方法之一,具有重要的临床意义。现就其分析方法学、影响因素、与心肌再灌注的关系及临床预后的价值予以评价。     

Inferior ST segment depression as a useful marker for identifying proximal left anterior descending artery occlusion during acute anterior myocardial infarction

To determine whether or not ST segment deviation on admissionelectrocardiograms can identify patients with anterior acutgemyocardial infarction due to proximal left anterior descendingartery occlusion, the magnitude and location of ST segment elevationor depression were compared between patients with proximal leftanterior descending artery occlusion (group A, n=47) and thosewith distal left anterior descending artery occlusion (groupB, n =59). ST segment depression in each of the inferior leadswas significantly greater in group A than in group B. The incidenceof ST segment depression 1 mm in each of the inferior leads(II; 81% vs 27%, III; 85% vs 54%, aVF; 87% vs 47%, P<0·01)was significantly higher in group A than in group B. In addition,the incidence of ST segment depression 1 mm in all of the inferiorleads was significantly greater in group A than in group B (77%vs 22%, P<0·01). In group A, maximal ST segment elevationwas more frequent in lead V alone (43% vs 14%, P<0·01).Group A had greater ST segment elevation in lead a VL than groupB, and the incidence of ST segment elevation 1 mm in lead aVL was significantly higher in group A than in group B (66%vs 47%, P<0·05). ST segment depression 1 mm in allof the inferior leads was most valuable for identifying groupA patients (77% sensitivity and 78% specificity). In contrast,the maximal ST segment elevation in lead V₂ alone or ST segmentelevation 1 mm in lead a VL had a low diagnostic value (43%sensitivity and 86% specificity, 66% sensitivity and 53% specificity,respectively). In conclusion, this study indicates that analysisof ST segment deviation in the inferior leads is useful foridentifying patients with acute anterior myocardial infarctiondue to proximal left anterior descending occlusion.     

Inferior ST segment depression as a useful marker for identifying proximal left anterior descending artery occlusion during acute anterior myocardial infarction

To determine whether or not ST segment deviation on admissionelectrocardiograms can identify patients with anterior acutgemyocardial infarction due to proximal left anterior descendingartery occlusion, the magnitude and location of ST segment elevationor depression were compared between patients with proximal leftanterior descending artery occlusion (group A, n=47) and thosewith distal left anterior descending artery occlusion (groupB, n =59). ST segment depression in each of the inferior leadswas significantly greater in group A than in group B. The incidenceof ST segment depression 1 mm in each of the inferior leads(II; 81% vs 27%, III; 85% vs 54%, aVF; 87% vs 47%, P<0.01)was significantly higher in group A than in group B. In addition,the incidence of ST segment depression 1 mm in all of the inferiorleads was significantly greater in group A than in group B (77%vs 22%, P<0.01). In group A, maximal ST segment elevationwas more frequent in lead V alone (43% vs 14%, P<0.01). GroupA had greater ST segment elevation in lead a VL than group B,and the incidence of ST segment elevation 1 mm in lead a VLwas significantly higher in group A than in group B (66% vs47%, P<0.05). ST segment depression 1 mm in all of the inferiorleads was most valuable for identifying group A patients (77%sensitivity and 78% specificity). In contrast, the maximal STsegment elevation in lead V₂ alone or ST segment elevation 1 mm in lead a VL had a low diagnostic value (43% sensitivityand 86% specificity, 66% sensitivity and 53% specificity, respectively).In conclusion, this study indicates that analysis of ST segmentdeviation in the inferior leads is useful for identifying patientswith acute anterior myocardial infarction due to proximal leftanterior descending occlusion.     

Precordial ST-Segment Depression in Inferior Myocardial Infarction is Associated with Slow Flow in the Non-Culprit Left Anterior Descending Artery

Background: Anterior precordial ST-segment depression (APSTD) is common in the setting of inferior myocardial infarction (IMI). The presence of APSTD correlates with increased risk of adverse outcomes in patients with acute IMI as well as more myocardium at risk as assessed by sestamibi, larger infarcts, lower ejection fractions, and more severe wall motion abnormalities in the infarct region. The ECG leads associated with APSTD (V1–V3) are generally thought to represent electrical activity subtended by the anterior myocardium, which is perfused by the left anterior descending artery (LAD). To determine whether APSTD is associated with abnormal blood flow in the uninvolved or non-culprit LAD, we assessed TIMI flow grades and corrected TIMI frame counts (CTFC) in both the culprit and non-culprit arteries of IMI patients. Methods: Data were drawn from the TIMI 10B trial of tenecteplase versus front-loaded tissue plasminogen activator in acute MI. Baseline ECGs were obtained within 12 hours of symptom onset, and angiography was performed 90 minutes following thrombolytic administration. A patient was considered to have precordial ST-segment depression if any ST-segment depression was present in any of leads V1–V3. Results: The majority of IMI's were due to right coronary artery occlusions, both in patients with APSTD (79.6%) and without APSTD (77.9%). In patients in whom the LAD was not the culprit artery but with APSTD were significantly less likely to have TIMI 3 flow at 90 minutes and more likely to have TIMI 2 flow. There was a trend toward slower CTFC in APSTD patients (27.2 ± 13.4 vs. 22.6 ± 8.5 frames/sec, p = 0.07). Conclusions: Among patients with acute IMI associated with precordial ST-segment depression, flow in the non-culprit left anterior descending artery was slower than that in patients without APSTD. This finding may partially explain the occurrence of APSTD in IMI. Abbreviated Abstract. It has previously been shown that patients with anterior precordial ST-segment depression (APSTD) have poorer clinical outcomes in the setting of acute MI. This study sought to determine whether APSTD is associated with abnormal blood flow in the LAD artery. Patients with acute IMI associated with APSTD had slower flow in the non-culprit LAD than patients without APSTD, which may partially explain the occurrence of APSTD in inferior MI.     

急性下壁心肌梗死伴胸前导联ST段压低的临床意义

评价急性下壁心肌梗死伴胸前导联ＳＴ段压低的临床意义。方法３３例急性下壁心肌梗死患者早期心电图与入院后３周冠脉造影对照，观察急性下壁心肌梗死伴胸前导联ＳＴ段压低与左前降支、多支血管病变、心肌酶峰值、ＳＴⅡ抬高〉ＳＴ；及右冠病变部位关系。