急性心肌梗死伴右束支传导阻滞的临床意义

目的　评价急性心肌梗死 (AMI)患者伴发右束支传导阻滞 (RBBB)的临床意义及预后。方法　将我院 5年来收治的AM重患者共 2 4 0例分为AM重伴RBBB组和不伴RBBB组。根据RBBB发生的时间、持续间期以及是否合并左束支分支阻滞将前者分为新发生RBBB、陈旧性RBBB、持续性RBBB、短暂性RBBB、双束支阻滞和单纯性RBBB 6个亚组 ,观察各组的临床经过和住院病死率。结果　AMI伴发RBBB 2 6例 ,占 10 8% ,与不伴RBBB比较 ,其CK峰值、恶性室性心律失常发生率、心功能不全发生率、住院病死率均显著增高 (P <0 0 1)。RBBB组高发的心功能不全发生率和住院病死率并非源自陈旧性RBBB和单纯性RBBB ,而是来源于新发生RBBB和双束支阻滞。新发生的持续性RBBB住院病死率最高 ,为 5 0 % ,短暂性RBBB为 11 1% ,而持续性RBBB的再灌注治疗率较短暂性RBBB明显降低 ( 2 5 %vs88 9% ,P <0 0 5 )。结论　AMI患者伴发RBBB提示预后不良。再灌注治疗可改善预后。     

右束支传导阻滞在急性心肌梗死中的临床意义

目的　评价伴随急性心肌梗死 (AMI)出现的右束支传导阻滞 (RBBB)的临床意义。方法　 2 94例 AMI分为RBBB组和非 RBBB组 ,比较两组患者的年龄、梗死部位、血清磷酸肌酸激酶 (CK)及其同工酶 (CK- MB)水平、心功能状态、严重并发症及住院死亡率。结果　 RBBB组血清 CK、CK- MB平均峰值为 (2 2 82 .0± 6 74.3) u/ L、(2 5 2 .6±137.3) u/ L ,明显高于非 RBBB组的 (192 0 .4± 5 6 9.2 ) u/ L、(114.8± 5 6 .7) u/ L (P<0 .0 0 5和 P<0 .0 1)。 RBBB组killip平均级别为 2 .33± 0 .5 4级 ,非 RBBB组为 1.46± 0 .6 3级 (P<0 .0 5 ) ,RBBB左心室舒张期末内径 (5 3.2± 9.6 m m )大于非 RBBB组 (4 5 .8± 8.2 m m,P<0 .0 5 ) ,左心室射血分数 [(4 8.9± 7.6 ) %]小于非 RBBB组 [(6 7.0± 3.7) %,P<0 .0 1]。 RBBB组心脏并发症发生率和住院死亡率高于非 RBBB组 (分别为 70 .8%和 39.0 %,P<0 .0 1;43.8%和 14.6 %,P<0 .0 1)。结论　 AMI并 RBBB患者梗死面积大 ,严重心脏并发症发生率和住院死亡率高。     

急性心肌梗死伴右束支传导阻滞的临床意义

目的 :评价急性心肌梗死 ( AMI)患者并发右束支传导阻滞 ( RBBB)的临床意义及预后。方法 :观察了 1995年 1月～ 1998年 5月 133例 AMI患者血清肌酸激酶 ( CK)及其同工酶 ( CK-MB)水平、严重并发症及死亡率。结果 :2 9例 AMI并发 RBBB(占 2 1.8% )者预后明显差于未并发RBBB者。表现为 CK及 CK- MB浓度更高 ,与心脏事件相关的并发症 (心力衰竭、完全性房室传导阻滞、心源性休克、心律失常 )发生率及死亡率均增高 ,经统计学处理 ,两组有极显著性差异 ( P <0 .0 0 5 )。结论 :AMI并发 RBBB可能是大面积梗死、心肌坏死严重的表现 ,可以作为一个预示危险的标志 ,对这些患者进行积极的介入性治疗 ,重建血管 ,可改善预后。     

右束支阻滞在急性心肌梗死中的意义

目的　了解伴随急性心肌梗死出现的右束支阻滞的临床和预后意义。　方法　将我院近5年收治的伴有新出现的持续性右束支阻滞的急性心肌梗死共 12例作为观察组 ,梗死部位均累及前间壁或前壁 ,故将同期收治的无束支阻滞的前间壁或前壁急性心肌梗死共 2 0例作为对照组 ,两组急性心肌梗死患者都在症状发生后 2 4h内收入院。分析两组的临床经过、住院病死率和随访 1年的情况。　结果　观察组血清 CK- MB平均峰值为 (2 48.2± 15 4.9) u,明显高于对照组的 (10 8.6± 6 4.2 ) u(P<0 .0 2 )。观察组 5 0 %并发室性心动过速或心室颤动 ,对照组为 2 5 %。观察组心功能受损也更严重 ,Killip平均级别为 2 .45± 0 .6 8,对照组为 (1.2 0± 0 .42 ,P<0 .0 0 5 ) ,左心室舒张末内径在观察组为 (5 6 .8± 11.0 ) mm ,对照组为 (4 7.0± 4.4) mm (P<0 .0 5 ) ,左心室射血分数在观察组为 0 .47± 0 .0 6 ,对照组为 (0 .6 5± 0 .0 9,P<0 .0 0 2 )。观察组的住院病死率为 2 5 % ,1年内因心力衰竭恶化再住院率为 44 %。　结论　伴随急性心肌梗死新出现的持续性右束支阻滞是临床经过凶险和预后不良的标志     

老年急性心肌梗死伴右束支传导阻滞近期预后分析

目的　研究老年急性心肌梗死 (AMI)伴右束支传导阻滞 (RBBB)患者的临床预后。　 方法　收集本院近 10年收住院老年AMI 2 0 3例患者的临床资料分为 2组 ,观察组 (伴有RBBB) 2 4例 ,对照组 (不伴RBBB) 179例 ,进行一般情况及并发病比较 ,临床经过及住院病死率比较。观察组再分为 3组 ,AMI伴新出现持久性RBBB组 13例 ,与AMI伴新出现短暂性RBBB组 6例及AMI既往有RBBB组 5例进行临床特点及病死率比较。　 结果 　 2组一般情况及并发病比较无明显差异 (P >0 .0 5 ) ,2组临床经过及住院病死率比较 ,观察组中的休克、恶性心律失常、前壁心肌梗死的发生率、病死率、心功能不全及房室传导阻滞均较对照组显著增高 (P <0 .0 5～ 0 0 1)。观察组中 3组比较 ,新出现持久性RBBB患者的前壁AMI及病死率比新出现短暂RBBB及既往有RBBB患者显著增高 (P <0 .0 5～ 0 0 1)。　 结论　AMI伴新出现持久性RBBB患者临床经过危险 ,预后不良。     

右束支阻滞对急性心肌梗死预后的判断

目的 :观察并发右束支阻滞的急性心肌梗死 (AMI)患者的临床预后。方法 :将该院近 7年收治的2 39例AMI患者分为两组 :对照组 ,无新发的右束支阻滞 ;观察组 ,为伴有新出现的右束支阻滞。后者又根据右束支阻滞持续时间长短及是否并发其他传导阻滞分为 4个亚组。分析各组并发心功能不全、恶性室性心律失常及住院病死率的情况。结果 :观察组恶性室性心律失常的发生率、心功能受损及住院病死率分别为 19.0 %、4 7.6 %、30 .0 % ,较对照组相应的 3.0 %、19.8%、17.3%有显著增加 (P <0 .0 5 ) ;但后二者并非源自于单纯右束支阻滞 ,而与并发的其他传导阻滞有显著相关性 (P <0 .0 5 ) ;右束支阻滞持续时间周期对心功能受损及住院病死率的影响亦有明显相关性 (P <0 .0 5 )。结论 :伴随AMI新出现的右束支阻滞使患者的预后不良     

急性下壁心肌梗死伴文氏型房室阻滞、4相右束支阻滞一例

患者男性 ,72岁。因胸骨后闷痛伴头晕、乏力 2d入院。既往健康 ,嗜酒。入院后急查心肌酶谱示谷氨酸转氨酶134U/L ,乳酸脱氢酶 5 5U/L ,肌酸磷酸激酶 4 79U/L ,肌酸磷酸激酶同工酶 2 3U/L ,入院前门诊心电图 (图 1、2 )显示急性下壁心肌梗死的表现。入院后给予吸氧、硝酸甘油 +多巴胺、地塞米松、肠溶阿司匹林及二磷酸果糖等治疗 ,病情缓解后出院。图 1　入院时的 12导联心电图梯形图中数据分别为心房周期、PR间期、心室周期 =心房周期 +PR间期递增量图 2　患者入院时Ⅱ导联心电图梯形图分析患者入院当天门诊 12导联同步心电图 (图 1)及…     

Diagnosing acute myocardial infarction in patients with left bundle branch block

We compared the clinical features, laboratory and coronary angiographic findings, treatments, and outcomes among patients with ST-segment elevation myocardial infarction (MI) with and without left bundle branch block (LBBB). We examined 5,742 patients with ST-segment elevation MI with and without LBBB treated with primary percutaneous coronary intervention in the Assessment of Pexelizumab in Acute Myocardial Infarction trial. The main outcome measures were obstructive coronary disease, MI, positive cardiac biomarkers, angiographic Thrombolysis In Myocardial Infarction flow, and death, MI, or congestive heart failure at 90 days. LBBB was present in 98 patients (1.7%). According to the protocol, patients with LBBB were eligible only if they had ≥1 mm concordant ST-segment elevation. Obstructive coronary artery disease was present in >87% of the patients with LBBB. Documented MI (elevated biomarkers) with an initially occluded infarct artery was more common in patients with LBBB with concordant ST-segment elevation (71.4%) than in patients without (44.1%; p = 0.027). The use of ST-segment elevation concordance criteria in the presence of LBBB was more often associated with documented MI with an identifiable culprit vessel with an initially occluded infarct-related artery. In conclusion, because a substantial proportion of patients with LBBB have acute MI with a culprit lesion and positive biomarkers, these data support immediate catheterization with the intent for primary percutaneous coronary intervention for all patients presenting with suspected ST-segment elevation myocardial infarction, ischemic symptoms, and presumed new LBBB, particularly if concordant ST-segment elevation is present.     

急性心肌梗死伴新发右束支阻滞的临床意义

目的 探讨急性心肌梗死（AMI）合并新发右束支阻滞（RBBB）的临床特征及意义.方法 回顾性分析同期住院的AMI伴新发RBBB（观察组）与同期住院的无新发RBBB患者（对照组）,比较两组的基线资料、心电图、冠状动脉造影（CAG）、肌钙蛋白（cTNI）滴度、血清肌酸激酶同工酶（CK-MB）峰值、心功能及院内主要不良心脏事件（MACE）.结果 观察组新发RBBB多继发于急性前侧壁心肌梗死,梗死相关动脉（IRA）以左冠状动脉前降支（LAD）近端多见;观察组cTNI滴度、（CK-MB）峰值、Killip平均分级、住院期间MACE发生率均明显高于对照组,而左室射血分数（LVEF）则低于对照组.结论 AMI合并新发RBBB提示心梗面积大,病情凶险,预后不良,应尽早行再灌注治疗.     

ECG diagnosis of acute myocardial infarction in patients with bundle branch block

The ECG diagnosis of myocardial infarction in the setting of bundle branch block is one that most physicians find difficult and that many erroneously believe to be impossible. Two case reports of a patient with right bundle branch block and of a patient with left bundle branch block are presented to illustrate instances in which the ECG diagnosis of myocardial infarction was both possible and essential. Methods for detecting ECG changes that indicate acute myocardial injury in the patient with bundle branch block are presented and applied to these cases.     

Right ventricular cardiomyopathy showing right bundle branch block and right precordial ST segment elevation

A 73-year-old man who had a family history of sudden death, experienced syncope. His electrocardiogram (ECG) presented right bundle branch block and right precordial ST segment elevation which are findings identical with those in Brugada syndrome. The cardiac MRI showed right ventricular mild dilatation, and endomyocardial biopsy revealed fatty replacement of myocardial fibers. Though no ventricular tachyarrhythmias were induced during an electrophysiologic test, the effects on ECG of antiarrhythmic agents and autonomic modulations were similar to those in Brugada syndrome. This case may suggest the relationship between Brugada syndrome and right ventricular cardiomyopathy.     

Vectorcardiographic monitoring of patients with acute myocardial infarction and chronic bundle branch block

AIM: This study was set up to describe vectorcardiographic patternsin patients with bundle-branch block and acute myocardial infarction. METHODS AND RESULTS: Sixty-five patients admitted to the coronary care unit withbundle-branch block and suspected acute myocardial infarctionwere monitored by dynamic vectorcardiography with trend analysis.In 28 patients, a clinical diagnosis of acute myocardial infarctionwas made. In patients with left bundle-branch block and acutemyocardial infarction, the pattern of QRS vector-differenceevolution was similar to that in patients with the narrow QRScomplex, while ST vector-magnitude changes increased over time.Using a cut-off value for QRS vector-difference at 12 h of morethan 20 µVs and a specific trend curve pattern, acutemyocardial infarction in the presence of left bundle-branchblock could be diagnosed with an accuracy of 71%. For patientswith right bundle branch block, using a maximum ST vector-magnitudeof >200 µV during the first 4 h, acute myocardial infarctioncould be diagnosed with a 78% accuracy. CONCLUSION: Our results indicate that dynamic vectorcardiography is a valuabletool in diagnosing and monitoring acute myocardial infarctionin patients with bundle branch block.     

ST segment elevation, right bundle branch block and sudden death: Brugada's syndrome

Brugada's syndrome is one of the main causes of sudden death in young adults without a structural heart disease. This is an electrical cardiac illness secondary to a mutation of SCN5A gene of chromosome 3 that has a dominant autosomic transmission pattern. This mutation implies the dysfunction of the sodium channel that increases the Ito, loosing the dome of the epicardiac action potential phase two. An "all or none" repolarization pattern ensues and gives rise to a phase two reentry. This kind of reentry is responsible for the initiation and perpetuation of malignant ventricular arrhythmias among these patients. The clinical characteristics of the syndrome are the right bundle branch block, ST segment elevation from V1 to V3 leads and sudden death or syncope. In some patients, a pharmacological test must be done with ajmaline or procainamide to unmask the electrocardiographic changes. At present, the only effective treatment is the implantable cardioverter defibrillator (ICD). This device has the capability to reduce mortality from 40% annually to 0% at ten years. Pharmacological treatment is not useful.     

急性前壁心肌梗死合并完全右束支传导阻滞患者心率变异性及临床预后分析

目的探讨急性前壁心肌梗死合并完全右束支传导阻滞(CRBBB)患者心率变异性(HRV)指标值变化,冠状动脉病变特点以及临床预后。方法选择新出现持续性CRBBB的急性前壁心肌梗死患者44例作为观察组,同期无束支传导阻滞的急性前壁心肌梗死患者225例作为对照组。两组患者均在发病1周内Holter监测一次,测HRV各指标值;比较两组发生恶性心律失常,冠脉病变及预后情况。结果观察组HRV各指标较对照组明显减低(P<0.01),观察组患者休克、心力衰竭、恶性心律失常的发生率明显高于对照组(P<0.01)。冠状造影显示所有患者均存在前降支病变,观察组多支病变发生率显著高于对照组(82%vs26%,P<0.01)。结论急性前壁心肌梗死合并CRBBB患者HRV各指标值明显减低,心肌损伤面积大,冠脉病变弥漫,临床预后差。