急性下壁心肌梗死患者合并右室梗死的心电图探讨

目的　探讨急性下壁心肌梗死合并右室梗死时的心电图变化。方法　对 118例首次发病后 12h以内急性下壁心肌梗死患者行动态描记心电图 ,并对心电图结果进行分析。结果　合并右室梗死者STV2 与STaVF两者无相关关系 (P >0 .0 5 )。不合并右室梗死者STV2 为 (- 0 .13± 1.73)mm ,STaVF为 (1.37± 1.2 3)mm ,两者之间呈负相关 (P <0 .0 1)。在诊断合并右室梗死方面 ,STV4 R和STV5R >1mm的敏感性为 10 0 % ;STV3R >1mm的敏感性为 86 .7% ;STV1 aVF>0 .5的敏感性为 87.5 % ,特异性为 6 2 .7% ;Ⅱ、Ⅲ导联ST段抬高的敏感性为 87.5 5 % ,特异性为 5 7.8%。合并右室梗死者中冠状动脉造影 6例、尸检 1例均为右冠状动脉近端病变 ,且均合并STV3R～V5R >1mm。结论　不合并右室梗死者胸前导联ST段抬高是aVF导联ST段压低的“镜像”表现 ;而合并右室梗死者“镜像”表现消失。STV4 R和STV5R>1mm诊断右室梗死的敏感性最高。STV3R～V5R>1mm预示右冠状动脉近端病变。

Investigation on the ECG manifestation of acute myocardial infarction of inferior wall complicated by right ventricular infarction

Objective To investigate the ECG manifestation of acute myocardial infarction of inferior wall complicated by right ventricular infarction(RVAMI).Methods 118 cases of first attack of inferior wall AMI were included in present study within 12 hours after onset of symptoms.Their ECG was recorded very 2～8 hours on the first day of onset,and then repeated every 12～24 hours.Results In the 16 cases with RVAMI,ST V 2 and ST aVF were and respectively. There was no correlation between them (P>0.05). In the 102 cases without RVAMI,ST V2 and ST aVF were and respectively. There was moderate inverse correlation between them (P< 0.01 ). In diagnosing complicated RVAMI, the sensitivity of ST V 4R and ST V 5R >1 mm was 100% and that of ST V 3R >1 mm was 86.7%. The sensitivity of ST V 1/aVF >0.5 was 87.5% and its specificity was 62.7%. When the elevation of ST segments in Ⅱ and Ⅲ leads was used as a diagnostic index of complicated RVAMI, its sensitivity was 87.5% and specificity was 57.8%. Of 16 cases with RVAMI, 6 cases received coronary artery angiography and 1 case autopsy.All these 7 cases had lesions at proximal portion of RCA and manifestations of ST V 3R～V 5R >1 mm.Conclusions 1.The "mirror phenomenon" between ST segment elevation in precordial lead and ST segment depression in aVF lead is one of the manifestations of the cases without RVAMI. The cases with RVAMI do not have the "mirror phenomenon." 2.In diagnosing RVAMI,ST V 4R and ST V 5R >1 mm has the highest sensitivity. 3. ST V 3R V 5R >1 mm may predict the occlusion of proximal portion of RCA.