左侧气胸的心电图特征及原因分析

目的探讨左侧气胸致心电图改变的特征及产生原因。方法回顾性分析50例左侧气胸患者的心电图和X线胸片资料。结果50例(100%)均呈R波逆递增,V1￣V6导联QRS波平均振幅呈V2>V3>V4>V5。左侧胸导联低电压39例(78%),而II、III、aVF导联QRS波振幅全部>0.5mV。顺钟向转位38例(76%),胸导联QRS波振幅随呼吸周期性改变31例(62%),胸导联QRS波振幅最大/最小的比值与气胸肺组织压缩程度呈正相关(p<0.05)。结论胸导联R波逆递增是左侧气胸最重要的特征性心电图改变,气胸的严重程度与胸导联QRS波振幅最大/最小的比值呈正比。     

心衰患者QRS波时限和振幅与心功能关系

目的 比较心力衰竭患者心电图QRS波不同时限及振幅时心功能的情况。方法 选择我院2018年4月至2021年4月住院治疗的心力衰竭患者97例作为观察组(A组),另选择同期48例健康体检者作为对照组(B组),收集并整理其完整心电图及临床资料。分析心衰不同QRS波振幅特点,对比两组∑QRS振幅、R_Ⅰ+S_Ⅲ振幅、R_V1+S_V5振幅;比较QRS<120ms、QRS≥120ms患者的∑QRS振幅、射血分数(LVEF)、左房内径(LAD)、左室舒张末期内径(LVEDd)指标。结果 观察组∑QRS振幅、R_Ⅰ+S_Ⅲ振幅、R_V1+S_V5振幅低于对照组(P<0.05)。QRS<120ms组的∑QRS振幅高出QRS≥120ms组(P<0.05)。两组LAD比较无差异(P>0.05),但QRS<120ms组LVEF高出QRS≥120ms组,LVEDd低于QRS≥120ms组(P<0.05)。...     

aVR导联的振幅与心衰预警

Madias的研究表明,12导联QRS波振幅之和(∑QRS)与体重的变化呈负相关:28例患者的平均体重从67.6kg增加到86.9kg时,∑QRS从120.2±41.6mV下降到54.8±26.9mV(p=0.0005)。体重与体表心电图关系的进一步研究发现,体重与胸导联V1￣V6导联的∑QRS相关性差,而与肢导、尤其是I和Ⅱ导联QRS波振幅明显相关。根据Kirchff’s第二电压理论:aVR=(I+Ⅱ)×1/2(右图),故单凭aVR导联QRS波振幅的变化则可监测患者体液潴留的动态改变。心衰患者心衰加     

慢性心衰患者心电图QRS波群振幅改变特点及其康复指导意义

目的 对慢性心衰患者心电图QRS波群振幅的改变特点进行分析并作出总结,探讨此种变化特点对康复指导的意义.方法 选取70例2017年2月-2019年8月在安阳市第二人民医院治疗的慢性心衰患者,将其列为观察组,根据本组患者的QRS波时限将其分成QRS波≥120 ms组(32例)和QRS波<120 ms组(38例),再选取40名同一时期在该院进行常规体检的健康者,将其列为对照组,对其均行心脏彩超、心电图等检查,观察并比较各组SV5+RVI振幅、SIII+RI振幅、12∑QRS总振幅(12导联QRS振幅之和),并对不同QRS波时限患者QRS总振幅、LVEDd、LVEF、LAD之间的差异性进行比较.结果 观察组SV5+RVI振幅、SIII+RI振幅、12∑QRS总振幅均低于对照组,两组结果 有明显的统计学意差异(P<0.05);观察组中,QRS波≥120 ms组患者QRS总振幅、LVEF均低于QRS波<120 ms组患者,左室舒张末期内径(LVEDd)大于QRS波<120 ms组患者,差异有统计学意义(P<0.05),但是两组左房内径(LAD)差异没有统计学意义(P>0.05).结论 慢性心衰患者其QRS波振幅随着时限的延长逐渐降低,且慢性心衰患者QRS波群振幅改变情况与其心功能的变化有着密切的相关性,临床上对慢性心衰患者实施康复治疗时,首先要详细掌握慢性心衰患者心电图QRS波群振幅改变情况的特点,并根据次特点为康复治疗的实施提供指导性的依据.     

B型预激综合征掩盖下壁心肌梗死1例

患者男,62岁。心电图示:B型预激综合征,慢性冠状动脉供血不足(图1A),给予对症处理后回家。12h后突发左胸钝痛,持续时间较长,急就诊。用同步3导心电图机记录Ⅱ、Ⅲ、aVL、aVF导联,第1、3组P-QRS-T为预激波群,第2组P-R间期>0.12s,QRS波为qR型,T波倒置(图1B),根据心     

静息心率与原发性高血压发病危险因素聚集性的分析

目的探讨静息心率与原发性高血压发病危险因素聚集性的关系及临床意义。方法对298例符合原发性高血压的患者进行问卷调查,每位患者均测静息心率、血压、空腹血糖(FPG)、总胆固醇(TC)、甘油三脂(TG)、高密度脂蛋白胆固醇(HDLc)、低密度脂蛋白胆固醇(LDLc)、纤维蛋白原(FG)及彩色多普勒超声心动图检查。根据检查结果将其分成4组:亚组1(有1项异常,n=106),亚组2(有2项异常,n=85),亚组3(有3项异常,n=69),亚组4(有3项以上异常,n=48)。另设102例正常血压组作为对照组。结果高血压各亚组间随着危险因素聚集性增多,静息心率逐渐增高。其中与对照组比较,亚组2、3和亚组4有显著差异(p<0.05,p<0.01和0.001),但与亚组1无差异(p>0.05)。等级相关分析显示:静息心率与高血压发病危险因素聚集程度呈正相关。结论静息心率与高血压动脉硬化的发展、靶器官损害及合并代谢异常有关。     

致心律失常性右心室心肌病右胸导联QRS时间延长的临床意义

目的探讨致心律失常性右心室心肌病右胸导联QRS时间延长的临床意义。方法收集致心律失常性右心室心肌病25例,分析临床和常规体表心电图特征,测量QRS时间、Q-T间期等各项参数,计算右胸导联(V1～V3)和左胸导联(V4～V6)QRS时间的平均值及两者之比。结果25例致心律失常性右心室心肌病病例的年龄(37.1±15.0)岁,其中男性12例,女性13例。常规心电图中Epsilon波阳性(第1组)11例(44.0%),其中63.6%(7/11)见于V1～V3导联;Epsilon波阴性14例(第2组)。所有患者的平均QRS离散度为36.3±27.2ms,Q-T离散度为57.2±27.1ms。平均QRS时间右胸导联[QRS1=(V1+V2+V3)/3]为0.13±0.03s,而左胸导联[QRS2=(V4+V5+V6)/3]为0.11±0.02s,差异有非常显著性意义(P<0.01)。QRS1/QRS2值为1.0～1.9,其中16例(61.5%)≥1.2。发生晕厥第1组8例(72.7%),而第2组4例(28.6%)(P<0.05)。两组的QRS1分别为0.14±0.04s、0.13±0.02s,QRS2分别为0.12±0.03s和0.11±.017s,QRS1/QRS2值为1.22±0.26和1.21±0.13,差异均无显著性意义(P>0.05)。结论右胸导联平均QRS时间延长有助于诊断致心律失常性右心室心肌病,但能否作为致心律失常性右心室心肌病预后的不良因素尚须进一步研究。     

心电图鉴别心肌淀粉样变与肥厚型心肌病

目的分析心肌淀粉样变及肥厚型心肌病患者心电图参数,获得能够简易快捷地诊断心肌淀粉样变及与肥厚型心肌病相鉴别的诊断流程。方法心肌淀粉样变患者(A组)、肥厚型心肌病患者(C组)、正常对照(B组)各30例,比较心电图参数特征,通过ROC曲线及logistic回归分析心电图参数的诊断价值并提出诊断流程。结果 A组肢体导联及左胸导联(V5、V6)低电压、假性梗死波及胸前导联R波递增不良比例较B组增高。诊断心肌淀粉样变(与B组鉴别):a VR导联QRS振幅(QRSa VR)联合PR间期减去P波时限(PR-P时限):敏感性96.30%,特异性96.67%,正确率96.49%。鉴别心肌淀粉样变与肥厚型心肌病:I导联QRS振幅(QRSI):界值0.46m V,敏感性90.00%,特异性96.67%;QRSa VR:界值0.41m V,敏感性93.33%,特异性93.33%;所有肢体导联QRS电压之和(6∑QRS):界值2.71m V,敏感性96.67%,特异性83.33%。结论心肌淀粉样变心电图多出现肢体导联及左胸导联低电压,假性梗死波,胸前导联R波递增不良等表现。QRSa VR联合PR-P时限可用于筛查心肌淀粉样变。QRSI、QRSa VR、6∑QRS可用于鉴别心肌淀粉样变和肥厚型心肌病。     

阿托品试验诱发3相不完全性结间束传导阻滞1例

患者男性,24岁.活动后时有胸闷2年,既往曾查心电图为“窦性心动过缓”.临床拟诊:病毒性心肌炎.静息心电图(图1左)示:窦性心动过缓.阿托品1.5mg静脉推注即刻心电图(图1中)示:Ⅱ导联P波极性、时间、P-R间期与图1左一致.P波振幅增高达0.3mV,伴P波上升支切迹,心率110次/min.至20min多次记录心电图心率均超过90次/min,P_(?)均高尖.45min后复查心电图(图1右)示:心率60次/min,P波形态、振幅恢复正常.心电图最后诊断:窦性心动过缓,阿托品试验阴性,阿托品试验揭示3相不完全性结间束传导阻滞.     

运动试验诱发交替预激综合征一例

患者,男,40岁,间有胸闷三年。过去多次心电图检查均正常。体查无特殊发现。心电图活动平板运动试验(Bruce 方案)、静息卧位心电图记录示窦性心律、心率81次/分,P—R 间期0.12秒、QRS 波正常。运动达 BruceⅡ级,心率131次/分,心电图出现 P—R 间期0.12秒、正常 QRS 波与 P—R 间期0.08秒、有明显预激(⊿)波的 QRS 图形交替出现。达预测心率后4秒,心率86次/分,⊿波消失,回复静息时的心电图。活动平板运动试验阴性;交替性预激综合征(简称预激)。讨论本例中年患者屡次静息心电图均正常,为评估胸闷性质作活动平板运动试验。运动中出现正常与预激相交替的图形,显露潜在性预激。潜在性预激指体表心电图无预激表现,但经心房起搏可诱发旁道     

Changes in high amplification ECG during the 2 years following the acute phase of myocardial infarction]

Late potentials have been reported 1 to 15 days after the onset of myocardial infarction but the evolution during long-term follow-up is not so well known. In order to determine if the signal averaged electrocardiogram remained stable or if it was necessary to repeat the investigation during a period of 2 years, 90 patients underwent 2 recordings on average 3 weeks after the onset of the infarct and then 2 years later. After the first recording, 16 patients (18%) had late potentials. The second recording was performed under the same conditions by the same operator. Globally, the signal averaged electrocardiogram recorded by Simson's method remained remarkably stable (83/90). It was rare to observe late potentials occurring for the first time after the initial recording (4 cases, 5%) in this study. It was more common to observe their disappearance (3 cases, 19%). No explanation could be found except in one case. These possible long-term changes in the signal averaged electrocardiogram suggest that the investigation should only be repeated in patients with abnormalities on the initial recording. Some authors have reported a better prognosis in patients in whom late potentials disappeared but this was not verified in this study.     

Manometrical study of the pharynx and the pharyngoesophageal sphincter in patients with polymyositis

The purposes of this paper are to evaluate degree of dysphagia at the pharyngeal stage of swallowing in patients with polymyositis. A catheter with three diode transducers 5 cm apart was swallowed through the nose into the upper esophagus. Firstly a patient was commanded to drink water of 2 ml at about five second intervals, and the swallowing pressures were recorded on condition that the speed of paper recording and catheter pull-through is the same 1 mm/sec. Secondly the swallowing pressures were recorded on condition that the middle transducer is fixed at the level of the upper esophageal sphincter and the speed of paper recording is 5 mm/sec. Thirdly the resting pressure of upper esophageal sphincter was recorded on the same condition of the first recording. The results were as follows: (1) All eight patients showed extremely low swallowing pressure at the all level of the pharynx compared with healthy men. (2) Four patients showed poor relaxation of the upper esophageal sphincter. (3) The resting pressure of the upper esophageal sphincter was low in seven. In polymyositis manometrical study of the pharynx and the pharyngoesophageal sphincter is a useful method for evaluating swallowing function.     

Complex fractionated electrograms in the right atrial free wall and the superior/posterior wall of the left atrium are affected by activity of the autonomic nervous system

CFAEs and Autonomic Nervous System . Background: Complex fractionated atrial electrograms (CFAEs) are supposed to be related to structural and electrical remodeling. Animal studies suggest a role of the autonomic nervous system (ANS). However, this has never been studied in humans. Objective: The goal of this study was to investigate the influence of ANS on CFAEs in patients with idiopathic atrial fibrillation (AF). Methods: Thirty‐six patients (28 men, 55 ± 9 years) were included before undergoing catheter ablation. In the 24 hours preceding the procedure, 20 patients were in AF (group 1) and 16 were in sinus rhythm (SR, group 2). With 2 decapolar catheters, 1 in the right atrium (RA) and 1 in the left atrium (LA), 20 unipolar electrograms were simultaneously recorded during a 100‐second AF‐period (in group 2 after induction of AF). After atropine and metoprolol administration, a second 100‐second AF‐period was recorded 30 minutes later. Five patients of group 2 served as controls and did not receive atropine and metoprolol prior to the second recording. CFAEs were assessed and the prevalence of CFAEs was expressed as percentage of the recording time. Results: The prevalence of CFAEs was greater in group 1 than in group 2 in both RA and LA (P = 0.026, P < 0.001, respectively). Atropine and metoprolol significantly reduced CFAEs in group 1 (P < 0.001) and prevented the time‐dependent increase of CFAEs in group 2. Conclusion: The prevalence of CFAEs is greater in long‐lasting AF episodes. Atropine and metoprolol administration reduces CFAEs in both atria. Thus, CFAEs are at least partly influenced by the ANS. (J Cardiovasc Electrophysiol, Vol. 23, pp. 26‐33, January 2012)     

Day-to-day variation of the frequency of ventricular premature contractions depends on variation of heart rates

To examine the manner in which spontaneous variation in the frequency of ventricular premature contractions (VPCs) relates to the variation of heart rate (HR), 68 patients with frequent VPCs were studied, by using 24-hour ECG recordings. All patients had more than 40 VPCs/hour on an initial 24-hour ECG recording and a second recording was made within 2 months (mean: 15 days). For each patient, the HR-dependency of VPCs was evaluated. Plots of VPC frequency per minute (VPCs/min) vs. HR were made at 1-beat/min steps for all HRs recorded for at least 5 min during 24 hours. Based on the patterns of correlation between VPCs/min and HR observed at the first recording, patients were divided into 2 groups: 1) 26 with a positive correlation or the P group (a linear increase in VPCs/min with increasing HRs) and 2) 42 with a non-positive correlation or the NP group. The NP group included: 1) an increased VPCs/min at low HRs and a decrease at high HRs (38 patients), 2) a linear decrease in VPCs/min with increased HRs (2 patients) and 3) constant VPCs/min at all HRs (2 patients). The patterns of correlation were reproducible at the second recording period in 65 of 68 patients (96%). Variability in the VPC frequency per 24 hours between two 24-hour recording periods was significantly greater in the P than in the NP group, while the variability in the mean daily HR was similar between the 2 groups. Thus, the 95% confidence limit for spontaneous reduction in the VPC frequency was greater for the P (67%) than for the NP group (50%).(ABSTRACT TRUNCATED AT 250 WORDS)     

Acute and long-term effects on myocardial ischemia of intermittent and continuous transdermal nitrate therapy in stable angina.

The aim of this study was to compare the efficacy and safety of continuous and intermittent transdermal nitrate therapy using ambulatory electrocardiographic (Holter) monitoring. Eighty-five patients with stable angina pectoris and positive exercise test results participated during their concomitant antiischemic medication in a randomized open trial lasting 12 weeks. After a 3-week run-in period with continuous therapy (10 mg/24 hours), patients were randomized to either continuous- or intermittent-therapy groups. In the intermittent-therapy group the patients removed their patch at night (the mean patch-off period was 10 hours). Forty-eight-hour Holter monitoring was performed in each patient after randomization, and again after 2 and 12 weeks. Eighteen patients withdrew, 9 in each group. A total of 11,194 hours of electrocardiography were recorded and 607 ischemic episodes were detected, of which 79% were asymptomatic and 95% appeared during daytime. The number of ischemic episodes per 48 hours with intermittent therapy was 3.1 +/- 0.7 (mean +/- SEM) after randomization, 1.8 +/- 0.4 at 2 weeks and 2.0 +/- 0.6 at 12 weeks. With continuous therapy the respective numbers were 3.8 +/- 1.1, 3.5 +/- 0.9 and 4.2 +/- 1.2. The differences were not statistically significant because a large number of patients (30%) had no ischemic episodes on Holter recording. However, when examining 47 patients with episodes during the study, the number of episodes was significantly reduced in the intermittent-therapy group (p less than 0.05 at 12 weeks). The changes in asymptomatic and symptomatic episodes were concordant. No changes and differences between the treatment groups were seen in nighttime episodes.(ABSTRACT TRUNCATED AT 250 WORDS)     

Limitations of the cardiokymograph for assessing left ventricular wall motion.

In order to evaluate the reliability and reproducibility of the CKG we studied four groups of patients. In 27 patients with a prior myocardial infarction the CKG recordings were compared to simultaneous wall motion videotracking. Identical wall motion was recorded in 75% of left ventricular sites and most of the discordant sites were false abnormal posterior wall motion recorded by the CKG. The second group consisted of 21 normal subjects studied by CKG only and 35% displayed anterior dyskinesis during expiration. The third group consisted of nine stable patients who were studied on two separate days by CKG and identical wall motion was recorded in only 55% of the sites on the two recordings. The final group consisted of seven patients with mitral regurgitation and all had late systolic outward movement posteriorly. Systolic wall motion was normal postoperatively in the three patients who underwent valve replacement. We conclude that: (1) the usefulness of the CKG is limited by the frequent recording of false wall motion abnormalities in normal subjects, (2) false anterior wall motion abnormalities can be reduced by recording during inspiration, (3) false posterior wall motion abnormalities may be due to systolic left atrial expansion, and (4) cardioxymography recordings are often not reproducible.     

Comparison of amplitude-modulated (direct) and frequency-modulated ambulatory techniques for recording ischemic electrocardiographic changes

Continuous ambulatory electrocardiographic monitoring of ST-segment configuration has become a useful technique for evaluation of myocardial ischemia. Concern that direct or amplitude-modulated (AM) recording and playback systems have inherent limitations that cause inaccurate ST-segment recordings has led to preference for frequency-modulated (FM) devices. To determine the accuracy of AM and FM ambulatory electrocardiographic systems, the signal was compared from the same set of 2 bipolar leads simultaneously recorded by standard electrocardiography and AM and FM recorders in 14 patients during treadmill exercise. Also, simultaneous AM and FM recorders were compared in 9 ambulatory patients in 16 monitoring sessions. The AM recording system accurately reproduced ST segments recorded during treadmill exercise (range 4.0 mm of ST-segment depression to 2.0 mm of ST elevation) when measured at the J point (r = 0.91, p less than 0.0001), and 0.08 second after the J point (r = 0.95, p less than 0.0001). FM recording was equally accurate (r = 0.89 and 0.95, respectively, p less than 0.0001). Similarly, during ambulatory recording, the AM technique accurately recorded maximal ST depression in each episode as recorded by the FM device (28 episodes, range 0 to 3 mm of ST depression, r = 0.85, p less than 0.0001). Both AM and FM ambulatory electrocardiographic systems can accurately reproduce ST-segment deviation associated with ischemia and can be used to monitor transient ST-segment changes in patients with coronary artery disease.     

Changes in high amplitude ECG during hospitalization for myocardial infarction]

The aim of this study was to determine the optimal time for recording the signal averaged electrocardiogram in order not to miss cardiac events after acute myocardial infarction. Three signal averaged electrocardiograms were recorded by Simson's method in the early post infarction period at Day 1 (24 to 48 hours after the onset of symptoms) at Day 8 (8 days after the onset) and Day 15 (2 weeks after the onset) in 66 patients. The results showed late potentials in only 18% of patients at Day 1 and that this was not related to a greater risk of ventricular arrhythmia in the acute phase. Late potentials were recorded in 34.8% of patients on Day 8 and 28.7% at Day 15. We suggest that signal averaged electrocardiography be performed one to two weeks after the onset of myocardial infarction; 13 of 66 patients had abnormalities at Day 8 but not on Day 1.     

肥厚心室肌钠钙交换体的表达水平对其电重构的影响研究

目的观察短时刺激对左心室肥厚模型心室肌电生理特性的影响,研究钠钙交换体在其中的作用。方法将15只纯种日本大耳白兔随机分为环缩组和对照组。环缩组手术环缩腹主动脉构建左心室肥厚模型．对照租仅游离出腹主动脉,不予结扎。8周后应用心脏电刺激单相动作电位记录技术测定两组心电生理参数。用免疫印迹方法定量心肌钠钙交换体。结果环缩组心脏重量／体重增加了32％。快速刺激后,环缩组心尖部心肌有效不应期明显延长,平均延长20ms（P〈0．01）;而对照组延长不明显,平均延长8ms（P〉0．05）。环缩组钠钙交换体蛋白量增加了52％,快速刺激引起的心尖部有效不应期的延长量与钠钙交换体表达水平明显相关（r=0．73）。结论肥厚心室肌钠钙交换体的表达水平明显上调,此与其快速刺激后有效不应期的明显延长相关,可能诱发室性心律失常。     

布地奈得和氢化可的松灌肠治疗溃疡性结肠炎的对比研究

目的:本实验对比观察布地奈得(BUD)和氢化可的松(HD)灌肠治疗轻中度远段溃疡性结肠炎(UC)的疗效 及副反应:建立高效液相色谱仪(HPLC)检测血和结肠粘膜中HD浓度的方法 方法:随机对照单(?)观察BUD组12例 HD组19例UC患者 治疗两周,比较两组在临床症状,结肠镜下,组织学及William疾病活动指数(DAI)几方面的变化同时观察副反应,并通过检测清晨皮质醇浓度来客观评价HD对肾上腺皮质的抑制作用 采用HPLC测定HD灌肠后不同时间血及肠粘膜活检组织中的该药浓度 结果:两组在临床症状,结肠镜下,组织学及DAI进步方面(?)L显著性差异(P>0.05)HD组2例出现颜面及双下肢水肿.而BUD组无此副反应:清晨皮质醇浓度变化两组有显著性差异(P<0.05)测出两例UC患者使用HD灌肠后粘膜及血中的药代学参数 结论:BUD和HD灌肠治疗(?)段UC临床疗效相当,前者副反应小 HD局部灌肠可能有部分全身作用