摘要
目的分析急性单纯后壁心肌梗死(不包括同时合并下壁及右室心肌梗死)的心电图及冠状动脉造影特点。方法总结自2001年至2006年门、急诊收治的急性单纯后壁心肌梗死患者11例,随访心电图特点,并行冠状动脉造影确定梗死相关动脉。结果 11例患者除了 V_7～V_9导联 ST段有典型的弓背向上抬高1.0～2.0mm 外,9例(81.8%)V_1～V_2导联 R/S≥1,5例(45.5%)V_1～V_4导联 ST 段压低1.0～2.0 mm,4例(36.4%)Ⅰ、aVL 导联 ST 段抬高0.5～1.5 mm,5例(45.5%)V_5～V_6导联 ST 段抬高0.5～1.5 mm。冠状动脉造影显示梗死相关动脉均为左回旋支(LCX)。梗死部位1例在第一钝缘支(OM1)发出前,为95%管状狭窄;6例(54.5%)在 OM1发出后,其中4例为100%闭塞,1例为99%次全闭塞,1例为90%长段狭窄;4例(36.4%)在 OM1,其中2例为100%闭塞,1例为99%次全闭塞,1例为95%局限性狭窄。单支病变3例(27.3%),合并左前降支(LAD)病变4例(36.4%),合并右冠状动脉(RCA)病变2例(18.2%),同时合并 LAD 及 RCA 病变2例(18.2%)。结论 12导联心电图,如有 V_1～V_2导联 R/S≥1,V_1～V_4导联 ST 段压低等特点时,结合临床与心肌酶学改变,高度怀疑急性后壁心肌梗死,需做后壁导联和冠状动脉造影加以证实,而梗死相关动脉多为左回旋支。
Objective To investigate electrocardiographic （ECG） and angiographic characteristics of patients with acute solitary posterior myocardial infarction. Patients complicated by inferior wall or right ventricular infarction were excluded.Method ECG and angiographic changes in 11 patients with acute solitary posterior myocardial infarction admitted to our emergency room from 2001 to 2006 were analyzed. Results Besides typical ST segment elevation in V7 - V9 leads, other ECG manifestations in these patients included V1 - V2 R/S ≥ 1 （9/11, 81.8% ）, 1 - 2 mm ST depression in V1 - V4 （5/11, 45.5% ）, 0. 5 - 1.5 mm ST elevation in [ ,aVL leads （4/11, 36. 4% ） and 0. 5 - 1.5 mm ST elevation in V5 - V6 leads （5/11, 45.5% ）. Coronary angiography showed that left circumflex artery （LCX） was the infarction related artery in all cases. The infarction area located before OM1 origination in 1 patient with a 95% pipelike stenosis （1/11）, after OM1 origination in 6 patients （6/11, 4 with total occlusion, 1 with sub-total occlusion and 1 with 90% long length stenosis）, in OM1 in 4 patients （4/11,2 with total occlusion, 1 with sub-total occlusion and 1 with 95% local stenosis）. There were 3 patients （27. 3% ） with single vessel lesion, 4 patients （36. 4% ） combined with left anterior descending artery （LAD） lesion, 2 patients （ 18.2% ） combined with right coronary artery （RCA） lesion and 2 patients （ 18.2% ） combined with LAD and RCA lesions. Conclusions Acute posterior myocardial infarction should be suspected with V1 - V2 R/S≥1 and V1 -V4 ST depression in standard 12 leads ECG. Besides symptoms and cardiac enzyme measurements, recording posterior leads electrocardiogram and performing coronary angiography will help to make the correct diagnosis.
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2007年第7期645-647,共3页
Chinese Journal of Cardiology
关键词
心肌梗塞
冠状动脉造影术
心电描记术
Myocardial infarction
Coronary angiography
Electrocardiogram
