胸导联T波直立的急性心肌梗死临床分析  

Significance of the upright T wave in precordial leads in patients with acute myocardial infarction

作　　者：蒋巍[1] 童欢 黄少华[1] 周贇[1] 王骏[1] 孙育民[1] Jiang wei;Tong huan;Huang shaohua;Zhou yun;Wang jun;Sun yumin(Jing'an District Centred Hospital,Shanghai,200040,China)

机构地区：[1]上海市静安区中心医院,200040

出　　处：《临床心电学杂志》2022年第2期110-113,共4页Journal of Clinical Electrocardiology

摘　　要：目的 分析心电图貌似正常的急性心肌梗死患者的胸导联特征,以及对梗死相关动脉(IRA)的判断价值。方法 回顾2018年1月至2019年12月急诊心电图貌似正常、冠脉造影诊断明确为急性心肌梗死患者的心电图资料,分析胸导联T波和QRS波特点。结果 10例患者经冠脉造影明确IRA为前降支(LAD)7例,回旋支(LCX)3例,心电图均显示胸导联T波直立,所有患者均T_(V2)/T_(V6)比值>1。IRA为LAD者经皮冠状动脉介入术后心电图均变为Wellens综合征II型改变,而IRA为LCX者均无明显变化。R_(V3)和R_(V2)/S_(V2)比值LCX组高于LAD组(p=0.03和0.02)。R_(V3)≥0.7mV者4例,其中3例IRA为LCX(1例为LAD者测值为0.7mV);R_(V2)/S_(V2)比值≥0.7者3例,其IRA均为LCX。结论 对有典型心绞痛样持续性胸痛、胸闷症状而心电图貌似正常者,需关注胸导联T波形态和右胸导联R波振幅,有助于急性心肌梗死的早期诊断和及时再灌注治疗。Objective To analyze the seemingly normal electrocardiogram(ECG) characteristics of precordial leads in patients with acute myocardial infarction and the ECG parameters of the infarct related artery(IRA). Methods The upright T wave and QRS complex characteristics of precordial leads data were analyzed retrospectively in patients with acute myocardial infarction from Janurary 2018 to December 2019, whose ECG seemed normal and the diagnosis was identified by emergency coronary angiography. Results Ten patients were enrolled, whose IRA was left anterior descending artery(LAD) in 7 patients and left circumflex artery(LCX) in 3 patients. All ECG showed upright T wave in precordial leads and T_(V2)/T_(V6)ratio>1. Wellens syndrome type Ⅱ ECG characteristics were developed in patients with LAD occlusion. However, no significant changes were observed in patients with LCX occlusion post percutaneous coronary intervention. The R_(V3) and R_(V2)/S_(V2) ratio in LCX group were higher than those in LAD group(p=0.03, p=0.02,respectively). R_(V3)≥0.7mV was found in 4 cases, including 3 patients with LCX occlusion(0.7mV in another case with LAD occlusion). R_(V2)/S_(V2)≥0.7 was detected in 3 cases and, all IRA was LCX. Conclusions Attention should be paid to the T wave and the R wave amplitude in the precordial leads in patients with typical angina pectoris-like persistent chest discomfort, even whose series ECG appear normal, which is helpful for the early diagnosis and timely reperfusion treatment of acute myocardial infarction.

关 键 词：急性心肌梗死 心电图 T波 梗死相关动脉 

分 类 号：R541.7[医药卫生—心血管疾病] R540.41[医药卫生—内科学]