急性下壁心肌梗死胸前导联ST段下移对近期预后影响的分析

急性下壁心肌梗死(AIMI)时ECG检查常表现有胸前导联的ST段下移。笔者通过对1995～2002年间我院收治的54例,AIMI患者中合并胸前导联ST段下移进行了临床分析，比较AIMI合并胸前导联ST段下移对心衰、心源性休克发生率、死亡率以及合并后壁心肌梗死，心肌的影响，探讨胸前导联段ST下移对AIMI近期预后的影响，为进一步做好临床治疗提供依据。     

急性下壁心肌梗死伴胸前导联ST段压低的临床意义

急性下壁心肌梗死伴胸导 ST段压低是临床常见现象。传统观点认为属心电图镜象改变 ,近来有人指出是心肌梗死区远距离缺血的结果 ,意义至今存有争议。现就此综述如下。1　下壁心肌梗死伴胸前导联 ST段压低的发生率Tendera等 [1 ] 报告 2 4例急性下壁心肌梗死 ,在发病 4小时内有 15例出现胸导段压低 ,发生率 62 % ,6小时后却仅有2 1%。 Birnbaum等 [2 ] 报道下壁心肌梗死中 64.4 %伴胸导 ST段压低。 Boden等 [3] 报道的 5 7例急性下壁心肌梗死中 2 1例出现胸导 ST段压低 ,发生率 3 7%。而多数作者 [4～ 1 3]统计结果在 5 0 %～ 60 % ,即…     

急性下壁心肌梗塞胸前导联ST段改变与冠脉病变的关系

急性下壁心肌梗塞早期准确诊断有重要的临床意义，尤其在溶栓疗法和经皮冠状动脉成形术等心肌梗塞现代治疗方法中．梗塞早期心电图是明确诊断、确定治疗方案的重要手段。本探讨急性下壁心肌梗塞胸前导联ST段改变与冠脉造影示冠脉病变的关系。     

急性下壁心肌梗死胸前导联ST段改变与冠脉病变的关系

目的探讨急性下壁心肌梗死(IAMI)患者胸前导联ST段改变与冠状动脉(冠脉)病变的关系。方法根据所选患者心电图胸前导联的ST段改变,将52例IAMI患者分为ST段正常组、ST段抬高组及ST段压低组,对所选患者进行选择性冠脉造影并比较各组患者冠脉病变情况。结果 ST段正常组18例,冠脉呈单支病变16例(88.9%),多支病变2例(11.1%);右冠脉远段病变10例。ST段抬高组13例,冠脉呈单支病变9例(69.2%),多支病变4例(30.8%);右冠脉近段病变6例,左前降支近段病变3例。ST段压低组21例,冠脉呈单支病变6例(28.6%),多支病变15例(71.4%);右冠脉远段病变11例,左前降支远段病变8例,回旋支远段病变6例(多支病变时,例数计算有重叠)。结论 IAMI伴胸前导联ST段压低者多提示冠脉多支病变,且远段病变多见;ST段抬高者多提示右冠脉及左前降支近段病变。     

急性下壁心肌梗死胸前导联ST段压低的临床意义

分析2001年1月-2004年3月本院68例急性下壁心肌梗死(AIMI)住院患者的临床资料,探讨胸前导联ST段压低与冠状动脉(冠脉)病变的关系及临床意义.     

急性下壁心肌梗死伴胸前导联ST段异常的临床意义

近年来，对急性下壁心肌梗死(以下简称LAMI)患者出现胸导ST段异常这一现象引起普遍重视，并非传统心电图导联“镜像”变化的观点，具有不同的临床意义。收集我院1980年3月～2003年12月收治的急性下壁心肌梗死患者胸导ST段变化进行临床分析。     

急性下壁心肌梗塞时心前导联心电图ST段压低的临床意义

为评价急性下壁心肌梗塞(AIMI)时心前导联ST段压低的意义,对43例心电图示透壁急性心肌梗塞患者进行了研究。其中,31例有心前导联ST段压低(甲组),12例无心前导联ST段压低(乙组),两组临床表现无差异。研究结果表明,甲组患者血清酶平均峰值显著升高且左室衰竭的发生率升高;甲组室性心律紊乱、心肌再梗塞、心源性休克和房室传导阻滞的发生率亦显著高于乙组(P>0.01～0.05)。本研究资料提示,AIMI时心前导联ST段压低可能与广泛性心肌缺血和危重并发症的发生率高有关,从而认为,可将之用来预测AIMI的临床严重程度,治疗效果和预后。     

急性下壁心肌梗死患者心电图胸前导联ST段下降与冠状动脉造影结果的对照研究

心电图目前仍然是急性和慢性冠脉综合征诊断的基石。心肌梗死是冠状动脉闭塞,血流中断,使部分心肌因严重的持续性缺血所致的威胁生命的疾病。随着冠脉介入诊疗技术的广泛开展,梗死的心电图改变和相关病变血管的关系逐渐被人们熟知。本研究旨在分析急性下壁心肌梗死患者心电图胸前导联趼段下降与冠状动脉造影结果,探讨急性下壁心肌梗死患者心电图胸前导联ST段下降的临床意义。现将相关资料总结分析如下。     

急性下壁心肌梗死胸前导联ST段改变的临床意义

目的分析急性下壁心肌梗死伴胸前导联ST段压低的临床意义。方法选择38例急性下壁心肌梗死患者常规心电图及24h动态心电图进行对照分析。结果急性下壁心肌梗死伴胸前导联ST段压低多于不伴胸前导联ST段压低(P<0.01);下壁伴正后壁心肌梗死伴胸前导联ST段压低多于不伴胸前导联ST段压低(P<0.01);下壁伴右心室心肌梗死与胸前导联ST段压低无明显关联(P<0.01);急性下壁心肌梗死伴胸前导联ST段压低者严重室性心律失常与房室传导阻滞的发生率较不伴胸前导联ST段压低者高(P<0.01)。结论急性下壁心肌梗死伴胸前导联ST段压低往往提示梗死范围大或同时存在心肌缺血、冠脉病变广泛、心功能损害较严重,并且严重室性心律失常与房室传导阻滞的发生率明显增高,心肌酶峰值明显增高临床预后较差。     

Prevalence of right ventricular myocardial infarction in patients with acute inferior wall myocardial infarction

The objective was to evaluate the prevalence of right ventricular myocardial infarction (RVMI) in patients with acute inferior wall myocardial infarction (IWMI) admitted to the National Institute of Cardiovascular Diseases, Karachi, Pakistan. Between August 2000 and May 2001, a total of 100 patients with acute IWMI were enrolled. History of all patients was taken, and thorough clinical examination was performed to asses the presence of signs of right ventricular infarction. Standard 12-lead electrocardiogram was recorded immediately on arrival of patients along with right precordial leads. All patients were considered for thrombolytic therapy in the absence of any contraindication and were managed with standard treatment strategies. Complications arising during the course of admission were recorded and compared between the two groups. There were 86 (86%) males and 14 (14%) females. Mean age was 56.3 +/- 13.13 years (range 33-83 years). The prevalence of RVMI in IWMI was 34%. Smoking and diabetes were more prevalent in RVMI group, while hypertension and family history of ischemic heart disease were more common in isolated IWMI. Ninety per cent of patients received thrombolytic therapy. In-hospital mortality (23.5%) was higher in RVMI group than isolated IWMI (18.1%). Other major complications were also higher in RVMI group than isolated IWMI. Right ventricular infarction was found in approximately one-third of IWMI. Right ventricular infarction was associated with considerable morbidity and mortality, and its presence defines a higher risk subgroup of patients with inferior wall left ventricular infarction.     

aVR导联ST段偏移性急性下壁心肌梗死的犯罪血管判断及预后分析

目的研究aVR导联ST段偏移对急性下壁心肌梗死（IAMI）犯罪血管的判断及预后分析。方法收集2000～2008年IAMI（包括同时伴右心室梗死）76例,按入院时aVR导联ST段有否偏移分为aVR导联ST段偏移组37例,无ST段偏移组39例,全部患者行冠状动脉造影术（发病后8小时内）,根据冠状动脉造影及临床资料,分析患者冠状动脉病变部位及临床预后。结果①ST段偏移组37例患者中,aVR导联ST段抬高26例,其中右冠状动脉（RCA）闭塞24例,左回旋支（LCX）闭塞2例;aVR导联ST段下移11例,其中RCA闭塞1例,LCX闭塞10例。②无ST段偏移组39例患者中,RCA闭塞37例,LCX闭塞2例。③ST段偏移组合并有糖尿病、并发症、心肌梗死后心绞痛的发生率及住院病死率均明显高于无ST段偏移组;ST段偏移组PCI后心肌缺血再灌注损伤的发生率明显高于无ST段偏移组。结论aVR导联ST段偏移情况对预测IAMI的犯罪血管、判断病情预后有较好的参考价值,是梗死相关动脉成功再通后心肌缺血再灌注损伤的强力预测因素。     

急性下壁心肌梗死伴aVR导联ST段压低的临床意义

目的探讨急性下壁心肌梗死伴aVR导联ST段压低的临床意义。方法对140例确诊急性下壁心肌梗死患者,依其心电图aVR导联ST段压低与否分为Ⅰ、Ⅱ两组,比较两组间的心肌型肌酸激酮同功酶(CK-MB)峰值,超声心动图,Holter,冠状动脉造影及各种临床并发症等结果。结果Ⅰ组患者与Ⅱ组患者比较,CK-MB峰值更高(160.21±93.42)U/L vs(124.68±62.95)U/L(P<0.01),左室射血分数减低更明显(54.78±9.22)%vs(59.50±7.14)%(P<0.05),并发症也更为多见。冠状动脉造影显示,在右冠状动脉阻塞的基础上更易合并左前降支或多支病变,各种临床并发症亦明显增高。结论急性下壁心肌梗死伴aVR导联ST段压低者梗死面积大,预后不良。     

右心室合并急性下壁心肌梗死患者临床特点分析

目的 探讨ST段抬高急性下壁心肌梗死（IWMI）伴或不伴右心室心肌梗死（RVMI）患者的临床特点。方法前瞻性研究92例急性IWMI患者的临床特点，根据入院时心电图V4R-V6R导联ST段是否抬高将患者分为IWMI合并RVMI组（34例）和单纯IWMI组（58例）。比较两组患者在主要危险因素、临床表现、治疗和并发症方面的差异。结果①单纯IWMI患者较IWMI合并RVMI患者有较高的冠心病家族史（P〈0．05）。②IWMI合并RVMI的惠者出现低血压、颈静脉怒张和Kussmaul征的比例明显增加（均为P〈0．01）。③IWMI合并RVMI患者需要更多的容量负荷（P〈0．01）和应用正性肌力药物维持血压（P〈0．01）。④IWMI合并RVMI患者有较高的病死率（P〈0．05）。结论与单纯IWMI患者比较。IWMI合并RVMI患者冠心病家族史较少，低血压、颈静脉怒张、Kussmaul征均较常见。病死率较高，治疗上更多需要容量负荷和应用正性肌力药物。     

Immediate diagnosis of acute inferior wall myocardial infarction with electrocardiographic pattern of only R-wave loss in inferior leads: a case report

The 12-lead electrocardiogram is an easily obtained, non-invasive method to assist in the diagnosis of an acute myocardial infarction. Traditional electrocardiographic criteria for diagnosing inferior myocardial infarction emphasize abnormalities of the initial large Q wave or ST segment elevation in leads II, III, and aVF. We report a case that has acute R-wave loss in inferior leads as an initial manifestation of acute inferior wall myocardial infarction. The patient was stabilized by coronary angioplasty.     

急性下壁或下后壁心肌梗塞并发右室梗塞心电图诊断指标的探讨

本文对125例首次急性下壁或下后壁心肌梗塞(MI)患者记录常规12导联心电图(ECG),并加作 V_7～V_9、V_3R～V_7R、CR_3R～CR_7R,发现合并右室梗塞者43例。结果提示:急性下壁或下后壁 MI时,除 STⅢ/Ⅱ>1可作为右室梗塞的诊断依据之一外,STaVL↓/aVF↑≤50%,STV_2+V_3↓/Ⅱ+Ⅲ↑≤50%可作为常规12导联 ECG 诊断右室梗塞的参考条件。     

头胸导联右胸心电图对急性右心室心肌梗塞的诊断

分析３４例正常对照组（组Ⅰ）和２４例急性左室下壁、右室梗塞组（组Ⅱ）患者ＷｉｌｓｏｎＶ３ＲＶ７Ｒ及头胸导联ＨＶ３ＲＨＶ７Ｒ右胸心电图。结果：组ⅠＶ５ＲＶ７Ｒ呈ＱＳ型者＞５０％，而ＨＶ３ＲＨＶ７Ｒ呈Ｒ或ｒＳ，均无ＳＴ段抬高；组Ⅱ两种心电图Ｑ波出现率相仿。比较组Ⅰ与组Ⅱ间病理Ｑ波出现率有显著性差异（Ｐ＜０．０１），在Ｗｉｌｓｏｎ导联仅见于Ｖ３Ｒ和Ｖ４Ｒ，在头胸导联则见于全部右胸导联。２４例右室梗塞患者头胸导联ＨＶ３ＲＨＶ７ＲＳＴ段抬高均＞０．１０ｍＶ，振幅高于同时间Ｗｉｌｓｏｎ导联０．０５～０．１５ｍＶ，持续时间＞７２小时，伴Ｔ波衍变。作者认为，此变化有助于急性右心室心肌梗塞的检出     

The presence of epsilon waves in a patient with acute right ventricular infarction

Epsilon wave is an unusual electrocardiographical finding, which may appear in other pathological conditions besides the arrhythmogenic right ventricular dysplasia, particularly in the acute myocardial infarction of the right ventricle, the inferior, or the posterior wall of the left ventricle. Its real incidence in these acute coronary syndromes remains unknown and will be probably difficult to assert, since it may be unnoticed by inexperienced physicians because of its little voltage. The outstanding interest of this case lies in the clear electrocardiographical images and in the step-by-step differential diagnosis discussed by the authors.