正常人右胸导联心电图T波形态的性别差异

目的探讨正常人右胸导联心电图男女T波形态差异规律及临床意义。方法测量240名正常人右胸导联心电图,比较男女T波形态及变化规律。结果Vl→V3R→V6R直立T波出现率逐渐减少,倒置T波出现率逐渐增多。女性以倒置T波为主,男性以直立T波多见,差异有显著意义(P<0.01)。V1→V6R的T波变化规律:可均倒置,女性多于男性(P<0.01);也可由直立→双相→平坦→倒置,男性多于女性(P<0.01),但未见由倒置→直立。结论正常人右胸导联心电图T波形态男女差异显著,应引起临床注意。     

正常人右胸导联心电图性别差异研究

目的 探讨性别差异对正常右胸导联心电图的影响。方法 选取900名正常人,男女各半,分年龄组分析右胸导联心电图的QRS波群、ST段及T波,比较男女变化规律。结果 V3R→V6RQRS波群振幅、ST段抬高率及振幅均为男性大于女性（P〈0.01）。T波女性以倒置为主,男性直立多见（P〈0.01）。V3R→V6R均倒置者女性多于男性（P〈0.01）;由直立、双相、平坦→倒置者男性多于女性（P〈0.01）。结论 正常人右胸导联心电图男女差异显著,应引起临床注意。     

正常人V1呈QS型的发生率及右胸导联心电图

目的总结正常人群中V1呈QS型的发生率及右胸导联心电图变化规律.方法在5395名健康体检者中,检出所有V1呈QS型的正常人,加做V3R～V6R心电图.结果V1呈QS型的正常人共54名,占全部体检人数的1%.V3R～V6R QS型发生率分别为100%、90.74%、59.26%、42.59%;Q波发生率分别为0%、9.26%、33.33%、37.04%;q波发生率分别为0%、0%、7.41%、20.37%.结论少数正常人V1可呈QS型.V1呈QS型的正常人右胸导联心电图出现QS、Q(q)波为正常现象.     

右心梗塞的心电图分析

本文通过对280例不同年龄和性别的正常右胸导联心电图各波段形态的观察,以及对11例临床诊断为右心梗塞患者的心电图分析,以期提高体表心电图对右心梗塞(RVI)的诊断水平。 1 280例正常人右胸导联ECG表现 1.1 P波:本组在V_3R—V_6R P波直立者258例占92％,其形态同V_1导联。14例为双相占5％,8例为平坦或倒置占3％。振幅<0.2mV,时限<0.10s,无明显年龄性别差异。 1.2 QRS形态:V_1、V_3R呈rS的263例占95％其余的     

右胸导联心电图诊断右室梗塞的价值综述

近年来右室梗塞(RVI)日益受到重视,为进一步掌握右胸导联心电图的诊断,本文将有关研究综述如下。 1 正常人右胸导联心电图 1.1 QRS波群 多数作者认为,正常成人右胸导联心电图有一定变化规律。即QRS呈rS型,以V_3R出现率最高,V_3R以右导联r波振幅依次递减或消失,S波振幅亦依次降低,QRS演变为qr或QS型。对于右胸导联Q波的研究,各家报导略有不同Andensen等强调正常人不应在全部右胸导联出现Q波,否则应疑及RVI;但有作者却认为,正常人V_3R—v_6R均可呈QS     

健康人右胸导联QRS波和T波形态分析

目的探讨健康人右胸导联心电图QRS波和T波形态及临床意义。方法测量867名健康人右胸导联心电图,分析QRS波和T波形态。结果右胸导联Q波的发生率与V1导联R波的幅度有密切关系,V1呈QS型、V3R～V5R多数有Q波。V1呈rS型,则R波幅度越小,V3R～V5R出现Q波的机会越大;右胸导联V1→V3R→V5R直立T波出现逐渐减少,倒置T波出现逐渐增多。结论健康人右胸导联心电图V1、V3R～V5R出现Q波和T波倒置不能作为诊断合并右室心肌梗（RVMI）的可靠依据。     

正常人右胸导联心电图QRS波群振幅性别、年龄差异研究

目的探讨正常人右胸导联心电图（RCLECG）QRS波群振幅性别、年龄差异规律。方法测量331名正常人右胸导联（RCL）QRS波群r、s波振幅,比较性别、年龄差异。结果男女各年龄组V3R～V6R导联r、s波振幅依次递减。同导联各年龄组之间：男性V3R-V6R导联r波振幅与年龄增长具有非常显著的负相关（P〈0．01）。V3R、V4R导联S波振幅与年龄增长呈负相关（P〈0．05）。女性r、s波振幅与年龄增长无显著的负相关（P〉0．05）。同年龄组男女之间：V3R—V6R导联QRS波群r、s波振幅均男性大于女性（P〈0．01）。结论正常人RCL ECG中QRS波群振幅性别、年龄差异显著,应引起临床注意。     

房性Q波与心房梗死

常规12导联心电图诊断心房梗死非常罕见,下面报告1例。患者女性,41岁。咳嗽、喘息、呼吸困难30余年,加重并胸闷1周就诊。图1右心房梗死图形临床诊断:支气管哮喘,可疑心肌梗死。心电图示:P波顺序发生,Ⅱ、Ⅲ、aVF导联P波呈负正双相,即出现房性Q波,aVR导联P波呈正负双相,胸导联也存在不同程度的房性Q波,P R间期0.10s,QRS波和ST T均无异常发现。加作右胸导联,V3R～5R呈rs型,V6R呈QS型,ST T亦无改变。心电图诊断:短P R综合征,房性Q波。讨论不伴随心室肌梗死的单纯性心房梗死几乎不可能从心电图上独立进行诊断。临床上心房梗死诊断率…     

不同胸静脉起搏时体表心电图P波特点

目的分析胸静脉起源的房性心律失常12导联体表心电图P波形态特点,为心律失常定位提供帮助。方法 35例药物治疗无效的阵发性心房颤动患者行射频消融前,将消融电极分别送至上肺静脉顶部,下肺静脉底部,上腔静脉靠间隔侧起搏。记录起搏前窦性心律(SR)下以及各部位起搏后体表12导联心电图P波图形,分析P波的振幅、时限、极性等形态特点。结果 P波时限左肺静脉比右肺静脉长。同侧上、下肺静脉P波时限无差异。下壁导联和胸导联上腔静脉比SR的P波时限长。P波振幅,SR下和各个胸静脉胸导联上无差异。下壁导联上同侧肺静脉比下肺静脉高,左、右肺静脉之间的P波振幅无差异,而上腔静脉比SR的P波振幅高。肺静脉的P波极性在胸导联都为正向波,而SR和SVC的P波极性在V1、V2导联可呈正向、负向及正负双向,其余胸导联为正向。结论不同胸静脉起源的心电图P波具有不同形态特点,可为临床胸静脉起源的房性心律失常定位提供帮助。     

"半模拟"12导联与常规12导联心电图各波段比较的实验研究

目的观察分析"半模拟"12导联与常规12导联心电图的异同之处,为12导联动态心电图诊断标准提供依据.方法比较200例正常人采用"半模拟"12导联及常规12导联记录的心电图各波段.结果"半模拟"12导联心电图无论是平卧位还是直立位,P波的形态、方向均几乎与常规一致,P波振幅普遍较常规增高,有8%的人直立位时表现为"肺型"P波;QRS波的形态在胸导联V1～V6及肢导联aVR与常规相似;在"半模拟"Ⅲ、aVF导联ST段表现与常规符合率较低(81.5～88%),其余导联的符合率较高,＞90%.有少数受检者部分导联ST段压低≥0.05mV,无一例超过0.1mV.T波在平卧位"半模拟"Ⅰ、Ⅱ、V1～V6导联与常规导联符合率较高,为99%～100%;"半模拟"12导联未见异常U波出现.结论如果采用常规心电图诊断标准,ST段压低超过0.1mV有病理意义的可能性大,胸导联QRS波形较肢导联QRS波形对室性心律失常定位较准确,出现异常U波有病理意义."半模拟"12导联心电图表现的左室肥大、右室肥大、异常深Q波不可轻率诊断.     

Ventricular tachycardia of left bundle branch block configuration in patients with isolated right ventricular dilatation. Clinical and electrophysiological features.

Electrophysiological studies showed ventricular tachycardia in five patients (four male, one female) with isolated right ventricular dilatation. All had been asymptomatic before the onset of palpitation which had developed in adolescence or early adult life. Tachycardia had been associated with syncope in four patients, and three had been resuscitated from ventricular fibrillation before investigation. The electrocardiogram during ventricular tachycardia showed a left bundle branch block pattern, and endocardial mapping at electrophysiological study confirmed the right ventricular origin. The presenting tachycardia could be induced in all patients by programmed stimulation, and in three patients ventricular tachycardia of differing configuration could be induced, but the right ventricular origin and left bundle branch block pattern were maintained. In two patients ventricular tachycardia degenerated into ventricular fibrillation. Cineangiography, cross sectional echocardiography, and multigated radionuclide angiography confirmed the dilated abnormal right ventricle while indicating that left ventricular function was normal. On resting electrocardiograms T wave inversion over the right precordial leads was the sole abnormality. There were no signs of right heart failure and exercise tolerance was normal. Four patients have received maintenance treatment with antiarrhythmic drugs, and one had undergone operative mapping and ablative surgery. Thus ventricular tachycardia complicating right ventricular dilatation may be associated with serious symptoms and ventricular electrical instability; and in adults it may be suspected on clinical grounds by inverted T waves in the right precordial leads.     

Ventricular tachycardia of left bundle branch block configuration in patients with isolated right ventricular dilatation. Clinical and electrophysiological features

Electrophysiological studies showed ventricular tachycardia in five patients (four male, one female) with isolated right ventricular dilatation. All had been asymptomatic before the onset of palpitation which had developed in adolescence or early adult life. Tachycardia had been associated with syncope in four patients, and three had been resuscitated from ventricular fibrillation before investigation. The electrocardiogram during ventricular tachycardia showed a left bundle branch block pattern, and endocardial mapping at electrophysiological study confirmed the right ventricular origin. The presenting tachycardia could be induced in all patients by programmed stimulation, and in three patients ventricular tachycardia of differing configuration could be induced, but the right ventricular origin and left bundle branch block pattern were maintained. In two patients ventricular tachycardia degenerated into ventricular fibrillation. Cineangiography, cross sectional echocardiography, and multigated radionuclide angiography confirmed the dilated abnormal right ventricle while indicating that left ventricular function was normal. On resting electrocardiograms T wave inversion over the right precordial leads was the sole abnormality. There were no signs of right heart failure and exercise tolerance was normal. Four patients have received maintenance treatment with antiarrhythmic drugs, and one had undergone operative mapping and ablative surgery. Thus ventricular tachycardia complicating right ventricular dilatation may be associated with serious symptoms and ventricular electrical instability; and in adults it may be suspected on clinical grounds by inverted T waves in the right precordial leads.     

The precordial lead in 104 normal adults

For the precordial lead the right arm electrode is placed on the anterior chest, just to the left of the sternum about the level of the apex, and the second electrode is on the left leg. The record is then taken as one usually derives Lead II of the standard electrocardiogram. This method is simpler than that of placing one electrode on the front and the other on the back of the chest.A simple glass electrode is described for obtaining precordial leads.It is suggested that the electrodes of the precordial lead be reversed so that P, R and T will be positive and only S inverted, just as they are in the standard electrocardiogram of normal adults.The precordial chest lead in 104 normal individuals is summarized. In this series the P-wave is shown to be negative, is not more than ?1.5 mm. and is usually followed by an end deflection above the isoelectric level. The P-Q interval averages 0.15 second. The QRS group is always diphasic, and never notched or slurred. Its duration is 0.09 second. The absence of the Q-wave or of the R-wave is definitely abnormal. The Q-wave averages ?5.3 mm. in size and the R-wave, +10.7 mm. No Q-wave less than ?1.5 mm. and no R-wave less than +2.5 mm. in size was ever observed. The R-T transition is below the isoelectric level, occasionally just isoelectric. A positive R-T transition or one that is more than 2 mm. below the isoelectric is definitely abnormal. The T-waves are always inverted and usually are less than ?6.0 mm. in size.The precordial lead may prove of service in interpreting which T-wave inversions of the third lead are abnormal.Left ventricular preponderance in the standard electrocardiogram of normal adults does not change the form of the precordial lead.     

Racial and sexual differences in the standard electrocardiogram of black vs white adolescents.

Standard 12-lead electrocardiograms were recorded in 114 healthy adolescents to substantiate possible influences of race and sex on the "juvenile pattern" (increased precordial voltages of QRS complex, precordial T wave inversions, and ST-segment elevations considered pathologic in adults) in this age group. Black male subjects had the highest precordial QRS amplitudes and the highest incidence of biphasic or negative precordial T waves and ST-segment deviations. In white male subjects, these findings were less pronounced but were more evident than in black or white female subjects. Results indicate the following: (1) race-specific and sex-specific normal electrocardiographic standards should be developed in adolescents; (2) criteria for left ventricular hypertrophy are race-specific and sex-specific and should be tested against independent anatomic or physiologic information in adolescents with left ventricular overload; and (3) the "juvenile pattern" may be viewed as a predictable continuum of age-related changes starting in childhood and progressing through adolescence on to later life.     

An electrocardiographic algorithm for determining the location of pacemaker electrode in patients with right bundle branch block configuration during permanent ventricular pacing

The expected morphology of right ventricular pacing is a left bundle branch block (LBBB) pattern. However, right bundle branch block (RBBB) can also be seen during permanent right ventricular pacing. The aim of this study was to develop an electrocardiographic algorithm to differentiate this benign condition from septal and free wall perforation with subsequent left ventricular pacing. Three hundred consecutive patients who had permanent ventricular or dual-chamber pacemaker implantation between 1999 and 2000 were screened and 25 patients (8.3%) who exhibited RBBB configuration were included in the study. Echocardiograms and chest radiographs were evaluated in order to identify the pacing lead location in this group. The authors formed a study group with their own 25 patients and 22 cases of RBBB with permanent pacemaker from previous publications (total 47 patients). Frontal axis, QRS morphology in lead V(1), and the precordial transition point, which is defined as the precordial lead where R wave amplitude is equal to S wave amplitude, were examined. Placement of precordial leads V(1) and V(2) 1 interspace lower than the standard location (Klein maneuver) eliminated the RBBB pattern in 12 patients. RBBB pattern with "true right ventricular pacing" was detected in 24 of the 25 patients, and in 11 of the 22 patients reported in the literature (total 35 patients). Right ventricular pacing was correctly identified in 34 of 35 patients with use of criteria including left superior axis deviation, RS or qR morphology in lead V(1), and precordial transition at lead V(3) with a high sensitivity and specificity. A simple surface electrocardiogram can accurately predict the lead location in patients having RBBB morphology with right ventricular pacing.     

Brugada波电交替及临床意义探讨

目的分析Brugada波的电交替现象。方法回顾性分析存在1型Brugada波且伴ST段和/或T波电交替现象的5例患者的心电图及临床特点。结果 5例患者均为男性,年龄18~50岁,入院时均存在1型Brugada波,并且分别在病因诊断确立或病情得到纠正过程中见到ST段和/或T波的电交替现象。ST段电交替可表现为抬高程度(高和低)的交替和抬高类型的(穹隆型和马鞍型)的交替,T波电交替表现为振幅(高和低)的交替和方向(双向和倒置)的交替。结论 Brugada波电交替现象可以发生于多种情况,同样具有多变性的特点。     

Giant P wave in a patient with right ventricular cardiomyopathy

A P wave of 7.5 mm in lead I and 12.5 in V1 was detected in a 28-year-old man, with a progressive cardiomegaly since the age of 14 years. At last admission he had minor symptoms, and a systolic murmur consistent with tricuspid regurgitation. The electrocardiogram showed an extremely tall P wave and a QRS of a very low amplitude; T waves were inverted on the precordial leads. These ECG features, and subsequent investigations, were consistent with right ventricular cardiomyopathy with massive tricuspid regurgitation, and right atrial abnormality.     

A case of a concealed type of Brugada syndrome with a J wave and mild ST-segment elevation in the inferolateral leads

We report a patient with a concealed type of Brugada syndrome. The electrocardiogram in the emergency department revealed atrial fibrillation with an almost normal ST segment. Slight electrocardiogram abnormalities of the J wave and mild ST-segment elevation appeared in the inferolateral leads a few days later. Although the ST segment in the right precordial leads, including that recorded from the high intercostal space recording sites, was completely normal, a drug challenge test using pilsicainide revealed a coved-type ST-segment elevation only in a modified V2 lead placed 1 or 2 intercostal spaces higher.     

Q waves and QS complexes

A Q wave or a QS complex on the electrocardiogram (ECG) is usually considered as the sign of an old myocardial infarction. While this is often true, the physician should not forget that other possibilities may exist, particularly in the elderly, for example, left ventricular hypertrophy (LVH) (including hypertrophic obstructive cardiomyopathy [HOCM]), cardiac amyloidosis, left intraventricular conduction disturbance, aberrant ventricular activation (WPW pre-excitation pattern). A QS complex in the limb leads or a Q wave in the precordial leads are sometimes the result of mistaken positioning of the electrodes. Furthermore, a Q wave in the inferior limb leads can sometimes disappear on deep inspiration. Similar changes may rarely be seen in normal subjects.