非冠心病患者心电图ST段弓背向上抬高10例报告

心电图ST段弓背向上抬高 (梗死样ST段抬高 )及异常Q波的出现 ,临床上以急性心肌梗死 (心梗 )及变异性心绞痛多见 ,但并非其特有 ,许多其他心血管疾病也可能出现。如何正确判断与识别 ,直接关系到对患者恰当的治疗与预后。我院 2 0 0 0年 1月～ 2 0 0 4年1月遇到 10例非冠心病患者心电图出现梗死样ST段抬高 ,伴或不伴病理性Q波 ,首诊均误诊为急性冠状动脉综合征。为全面了解心电图ST段抬高的临床意义 ,提高诊断符合率 ,现将 10例临床资料分析如下。1　临床资料1 1　病毒性心肌炎　本组 4例 ,男、女各 2例 ;年龄2 6～ 6 5岁。 3例表现为胸…     

心电图酷似急性心肌梗死改变的老年急性心肌炎1例分析

病毒性心肌炎均有心电图异常,这种异常多为各种早搏,心动过速或传导阻滞。而少数年轻人心电图可表现为ST段抬高,病理性Q波,酷似心肌梗死图形。老年人极少见。现将1例老年心肌炎出现急性心肌梗死图形的病例报告如下。     

26例早期心肌梗塞的心电图分析

急性心肌梗塞为内科常见急症之一。其心电图诊断一般是依靠出现病理性Q波、ST段抬高及T波改变。Schamroth根据心肌梗塞的电病理学改变将其分为三个重要时期：超急性损伤期一早期、充分进展期和慢眭稳定期。早期的心电图改变包括：斜升ST段（即J点上移）、巨大高耸的T波和R波而无Q波。据此标准，现将本院近年来收治的26例早期心肌梗塞的心电图变化分析报道如下。     

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。     

出血性脑卒中似AMI样心电图改变7例报告

在某些严重急性脑血管意外中,可出现酷似急性心肌梗塞的“坏死、损伤、缺血”样心电图改变,易误诊为“急性心肌梗塞”.现将临床所遇7例报告如下.1临床资料及典型病例介绍本文所介绍的病例是在61例经头颅CT片或腰穿确诊为出血性脑卒中患者发生心电图改变的40例之内出现酷似心肌梗塞样心电图变化的7份病例.其中男性5例,女性2例.蛛网膜下腔出血4例,脑出血3例.4例仅有ST段上升伴T波改变,无病理性Q波;3例既有病理性Q波,又伴有ST段上升及T波缺血性改变,这3例均为蛛网膜下腔出血.     

急性心肌梗死108例心电图分析

目的对急性心肌梗死(AMI)患者的心电图进行了统计分析,以了解AMI患者的心电图特点。方法收集临床诊断AMI患者108例的心电图及相关的症状、体征及心律失常等资料。结果 50~59岁男性患者AMI发病率最高,下壁心肌梗死,广泛前壁心肌梗死发病率较高,入院后观察到典型的ST段抬高和Q波出现的AMI患者在临床上不足60%。结论部分AMI患者ECG没有典型表现,要注意对ST段、T波及异常Q波特点的观察,特别是注意其动态变化,避免误诊误治。     

业务测验(54)答案和题解

题解1.病理胜Q波往往反映心肌坏死或某些心脏病的心电图改变,如肥厚型心肌病也可出现病理性Q波,但不一定代表心肌坏死。ST段弓背型抬高往往反映心脏损伤或心室壁瘤形成。J点下降可见于多种情况,必须结合临床进行分析,而ST段呈鱼钩样降     

心肌肌钙蛋白Ⅰ峰浓度结合心电图改变早期估测急性心肌梗死患者病情和预后的作用

目的:探讨血清心肌肌钙蛋白I(cTnI)峰浓度与心电图(ECG)ST段抬高、病理性Q波对早期估测急性心肌梗死(AMI)患者病情及预后的作用。方法:对120例AMI患者在来急诊24h内不同时间段采血测定cTnI峰浓度,同时检查标准18导联ECG,分别统计出不同ST段抬高及病理性Q波的导联数之间血清cTnI峰浓度的变化。结果:ST段抬高数目中A(2～3个)、B(4～5个)、C(≥6个)3组血清cTnI峰浓度组间比较,分别计算q=3.590、7.572和5.236,P<0.05或<0.01;病理性Q波数目中D(0～3个)、E(4～5个)、F(≥6个)3组血清cTnI峰浓度组间比较,分别计算q=5.361、4.392和4.573,P<0.01,差异有显著性。结论:cTnI峰浓度与ECG出现ST段抬高和病理性Q波的导联数有密切关系,对早期判断AMI患者的病情及预后有重要意义。     

心电网络中碎裂QRS波对心肌梗死的诊断价值分析

目的:探究心肌梗死患者出现心电图碎裂QRS波诊断的价值。方法:选取心肌梗死患者50例为实验组,时间选取为2013年5月-2018年5月,同时选取急性冠脉综合征患者50例为对照组,其均接受心电图检查,对其检测结果进行回顾性分析。结果:实验组心肌梗死患者下壁以及前壁碎裂QRS波、病理性Q波检出率均高于对照组急性冠脉综合征患者(P0.05);2组ST抬高检出率与碎裂QRS波、病理性Q波、碎裂QRS波联合病理性Q波诊断准确率相比,无统计学意义(P0.05);碎裂QRS波联合病理性Q波诊断的准确率明显高于单独碎裂QRS波、单独病理性Q波诊断的准确率(P0.05)。结论:心肌梗死患者疾病诊断中,碎裂QRS波可作为其疾病诊断的辅助指标,同时与病理性Q波联合,可提高诊断的准确率。     

急性高血糖致非梗死性Q波与ST段抬高心电图表现10例分析

现将我院近期收集糖尿病患者10例，急性血糖升高致异常Q波与ST段抬高心电图分析如下。     

Electrocardiographic findings and myocardial damage in acute myocarditis detected by cardiac magnetic resonance

Delayed-contrast-enhancement (DCE) magnetic resonance imaging (MRI) can identify areas of myocardial damage in patients with acute myocarditis (AM). The aim of this study was to assess the electrocardiographic findings in AM diagnosed by DCE-MRI. Eighty-one patients (72 men, 35 ± 13 years) with AM were prospectively enrolled. All of them underwent MRI and 12-lead-ECG recordings. In the admission electrocardiogram (ECG 1), as well as in that obtained 48 h later (ECG 2), the following parameters were analyzed: rhythm, PR, QRS, and QTc-intervals, intraventricular conduction, abnormal Q waves, ST segment elevation, and T wave inversion. On admission, 77 patients (95%) were in sinus rhythm, while four patients (6%) manifested severe arrhythmias. No difference between ECG 1 and ECG 2 was observed regarding abnormal Q waves, PR, QRS, and QTc-intervals. Electrocardiogram 1 was normal in 26 patients (32%, normal ECG group), and abnormal in 55 patients (68%, abnormal ECG group). ST elevation was found in 46 patients (57%), inverted T wave in seven patients (9%) and left bundle branch block (LBBB) in two patients (3%). Areas of DCE suggesting AM were found in each patient. No relationship concerning the location of the involved region (s) was found between ECG (leads with ST/T abnormalities) and MRI (areas showing DCE). The ECG in AM can either be normal or reflect abnormalities including arrhythmias, LBBB, ST segment elevation, and T wave inversion. The location of myocardial involvement deduced on the basis of ECG leads showing ST/T changes is not in close relationship with the areas of ventricular damage detected by MRI.     

Abnormal electrocardiographic findings in apheresis donors

Electrocardiographic (ECG) monitoring was performed on 291 donors during apheresis. Twenty-one donors (7.2%) had clinical symptoms such as discomfort, nausea, chill, numbness, and paresthesia, and 13 of this group exhibited ECG abnormalities, such as tachycardia, bradycardia, and other abnormal wave patterns. The donors with tachycardia and slight bradycardia had no symptoms. Ten donors had moderate to severe bradycardia with pulse rates less than 50 beats per minute; four of them had severe bradycardia (less than 45 beats per minute), and three of the four exhibited severe hypotension, vomiting, fainting, or convulsion. Other abnormal ECG changes, such as supraventricular and ventricular premature contractions, right bundle branch block, ST segment elevation or ST segment depression, and tall, flattened, or inverted T waves were observed in 29 donors (10%). These changes were not associated with symptoms. Only three of these donors complained of discomfort or chest heaviness. The abnormal waves appeared more often in granulocytapheresis donors than in plateletapheresis donors.     

急性脑血管病心电图特点及分析论著

目的分析急性脑血管病心电图异常的特点,并讨论其发生的机制。方法对249例经头颅CT确诊为急性脑血管病患者在入院24 h内做标准导联心电图检查。结果 249例患者心电图的异常率为69.1%(172/249),其中脑出血异常率64.3%(18/28);脑梗死异常率69.7%(154/221),两者比较差异无统计学意义(P<0.05)。ST-T改变的发生率最高,其次为传导阻滞,与Q-T间期延长、p波增宽、左心室肥厚、心律失常、低电压比较差异有统计学意义(P<0.05)。心电图正常组病死率1.3%(1/77),心电图异常组病死率7.6%(13/172),两组病死率比较差异有统计学意义(P<0.05)。结论急性脑血管病患者中心电图异常发生率较高,以心肌缺血和传导阻滞为主。心电图异常组病死率高,临床工作中应关注急性脑血管病患者的心电图改变,及时给予适当处理。     

脑心综合征心电图变化影响因素的临床研究

目的 探讨脑卒中患者的心电图变化的影响因素。方法 对165例脑卒中患者进行分析。均在入院24h内完成心电图检查,以后每周定期复查心电图。结果 心电图异常率为102例（61．8％）,其中按脑卒中性质统计：脑出血组〉蛛网膜下腔出血组〉脑梗塞组;按病变部位统计：脑干,丘脑、基底节组〉内囊、大脑皮质、脑叶组;按意识状态统计：昏迷或嗜睡组〉清醒组;按血糖水平统计：高血糖组〉血糖正常组;按疾病转归统计：死亡组〉好转组。结论 脑卒中异常心电图与脑卒中性质、部位、意识状态、血糖水平、疾病转归有关。     

变异型心绞痛患者66例12导联同步动态心电图分析

目的探讨动态心电图对变异型心绞痛患者的诊断价值。方法对66例变异型心绞痛患者应用常规心电图(ECG)、24 h动态心电图(DCG)检测,对两种方法进行比较。同时应用DCG分析心绞痛发作次数和时间。结果损伤型ST段抬高(0.2~1.2 mV)伴对应导联ST段下移,T波高耸对应导联T波倒置或低平,室性期前收缩,加速性室性逸搏,房室传导阻滞,巨型R波,U波倒置检出率DCG为25.8%、72.7%、54.5%、36.4%、40.9%、22.7%、10.6%;ECG检出率为3.0%、7.6%、4.5%、1.5%、3.0%、1.5%、1.5%;两者比较有非常显著性差异(P<0.05)。心电图异常发作高峰时间在00∶00~08∶00。结论 DCG能够表现变异型心绞痛的全过程,对提高VAP的诊断率具有重要价值。     

急性脑出血患者150例的心电图改变及护理体会

目的 观察急性脑出血患者心电图的改变及其相关因素,并探讨其护理方法.方法 观察150例脑出血患者的心电图变化,根据出血部位、出血量、血肿是否破入脑室及患者年龄进行分组比较,并分析异常心电图与脑出血预后的关系.结果 脑出血患者心电图异常率高达84%,以ST-T波改变为主,以中心型病灶组、出血量多组、血肿破入脑室组和老年组心电图异常率均较高;心电图异常者病死率明显高于心电图正常者.结论 急性脑出血患者常伴有心电图的异常,其心电图异常率与出血部位、出血量、血肿是否破入脑室及患者年龄有关;脑出血后心电图异常提示预后不良.根据心电图的异常有助于早期、及时地发现和预防心脏并发症,减轻患者痛苦,降低病死率.     

Within- and Between-Patient Variation of the Signal-Averaged P Wave in Coronary Artery Disease

Objectives: To estimate interobserver, within-patient and between-patient variation of the signal-averaged P wave. To determine whether demographic, clinical, conventional ECG information, and coronary angiographic data are associated with the signal-averaged P wave duration in patients with documented coronary artery disease. Background: A prolonged signal-averaged P wave may indicate the presence of a substrate for atrial tachyarrhythmias and may predict subsequent development of atrial fibrillation. However, information on variation, reproducibility, and determinants of the signal-averaged P wave are sparse. Methods: One hundred ninety-three patients with angiographically documented coronary artery disease underwent two consecutive procedures of signal-averaging of P waves (SAECG1 and SAECG2). Interobserver, within-patient, and between-patient variation of the signal-averaged P wave was estimated (coefficient of variation: SD/mean). Multiple linear regression analysis was applied to identify parameters independently associated with signal-averaged P wave duration (SA-P). Atrial late potentials were considered if SA-P > 140 ms, and logistic regression analysis was applied to identify parameters associated with the presence of atrial late potentials. Results: The interobserver, within-patient, and between-patient coefficients of variation for the signal-averaged P wave duration were 7.5%, 6.0%, and 8.4%, respectively. The signal-averaged P wave duration correlated significantly with standard ECG P wave duration and height of the patient (r = 0.59). Forty-nine percent of the patients had atrial late potentials. P wave duration in the standard ECG correctly classified 73% (140/188) of the patients with respect to atrial late potential positivity or negativity. The sensitivity was 67% and the specificity was 78%. Agreement on the presence or absence of atrial late potentials between two observers was present in 71% (136/193) of the patients, and in 78% (151/193) between SAECG1 and SAECG2. Conclusions: The signal-averaged P wave has limited reproducibility in patients with coronary artery disease, and a normal or abnormal signal-averaged P wave can be predicted from the conventional ECG with high accuracy. It is recommended that the signal-averaged P wave be compared with the standard ECG P wave duration in follow-up studies with the aim of predicting atrial fibrillation.     

36例乙型肝炎病人病毒核糖核酸、肌钙蛋白Ⅰ与心电图改变关系的探讨

目的:研究乙型肝炎(HB)病人血清乙型肝炎病毒脱氧核糖核酸(HBV-DNA)、肌钙蛋白Ⅰ(cTnⅠ)与心电图(ECG)改变三者的关系,探讨HBV对心肌损伤的机理。方法:收集36例HB的临床资料及ECG的变化,并检测血清HBV-DNA、cTn Ⅰ含量。结果:急性肝炎患者血清HBV-DNA含量明显高于慢性肝炎;各型肝炎cTn Ⅰ的阳性率不等,总阳性率为22.2%(8 36)。急性、慢性重度、慢性中度、肝硬化、慢性轻度的阳性率分别为50%(2/4)、25%(1/4)、23.4%(3、1 3)、14.2%、(1 7)、12.1%(1/8),急性肝炎明显高于其它各组(P<0.01)。慢性中度、莺度与慢性轻度、肝硬化之间也有显著差异(P<0.01)。慢性轻度与肝硬化之间、慢性中度与慢性重度之间无显著差异。HB病人ECG异常发生率为36.1%(13/36),4例急性肝炎患者均有过ECG改变,显著高于其它各组(P<0.01)。结论:1)cTn Ⅰ阳性与ECG异常表现并不一致,cTn Ⅰ可以作为判断HB心肌损伤的敏感和特异性指标;2)在HB急性期的心肌损伤可能是HBV直接作用,慢性HB心肌损伤是自身免疫作用的结果。     

302例登革热心电图特征研究

目的 分析登革热患者心电图的特征。方法 回顾性分析302例登革热患者（登革热组）和同期300名健康体检者（对照组）的临床资料,对比2组心电图异常情况;进一步分析异常心电图治疗前后的变化及其特点。结果 登革热组存在心电图异常的患者比例（51.32%,155/302）高于对照组（31.00%,93/300）（P < 0.001）;登革热组心电图异常发生频率高于对照组的有ST-T改变（27.81%,84/302）、窦性心动过缓（11.92%,36/302）（P均< 0.05）;有46例心电图异常的患者治疗后复查了心电图,其中窦性心动过缓发生频率较治疗前下降,差异有统计学意义（P < 0.05）;窦性心动过缓的患者共36例,16例（44.44%）合并ST-T改变,高于无窦性心动过缓的患者（25.56%,68/266）,差异有统计学意义（P < 0.05）。结论 登革热患者心电图异常较普遍,主要表现为ST-T改变、窦性心动过缓;窦性心动过缓是登革热最常见的心律失常和较显著的心电图特征,可能有助于诊断登革热。