急性ST段抬高型心肌梗死的非典型心电图改变

心电图是广泛使用和容易获得的最初诊断工具。急性心肌梗死（AMI）的治疗有赖于其临床表现、心电图及心肌坏死标志物的综合判断。识别高危心电图及其微妙变化将使患者早期血运重建明显获益。本文主要对非典型的心电图诊断相当于急性ST段抬高型心肌梗死（STEMI）的一些规律，包括左束支传导阻滞（LBBB）满足Sgarbossa标准、Wellens′综合征、QRS波终末变形、超急性T波、de Winter征和aVR导联抬高等进行综述。

Atypical electrocardiogram changes in acute ST-segment elevation myocardial infarction

Electrocardiogram (ECG) is widely used and flexible to obtain as an initial diagnostic tool. Optimal treatment of acute myocardial infarction (AMI) relies on the comprehensive diagnosis based on clinical manifestations, ECG changes, and myocardial necrosis markers. Identifying subtle high-risk ECG changes will bring obvious benefit to early revascularization in AMI patients. This review mainly discusses atypical STEMI-equivalent ECG changes, including left bundle branch block (LBBB) satisfying the standard of Sgarbossa criteria, Wellens′ syndrome, terminal QRS distortion, hyperacute T-waves, De Winter pattern, and elevation in lead aVR.