急性心肌梗死不典型心电图32例临床分析

Clinical analysis of atypical electrocardiograms of acute myocardial infarction

目的探讨急性心肌梗死(AMI)不典型心电图的表现及临床意义。方法分析32例心电图不典型急性心肌梗死患者的心电图资料。结果 AMI不典型心电图常见于非ST段抬高型心肌梗死(10例)、心肌梗死早期(4例)、同部位多次心肌梗死(2例)、心肌梗死合并束支阻滞(6例)、合并后壁心肌梗死(2例)、小面积心肌梗死(6例)、记录导联不正确及U波倒置之患者(2例)。不典型心电图改变包括:显著而持续性ST段压低及T波倒置、T波高耸、R波递增不良或逆递增、束支传导阻滞掩盖心梗图形、及U波倒置等。结论对心电图不典型的心肌梗死患者应不断动态观察心电图及心肌酶改变,及时明确诊断,避免误诊及漏诊。

Objective To discuss the acute myocardial infarction （AMI） with atypical ECG perform and clinical significance,improve the diagnostic ability of AMI.Methods Atypical ECG of 32 cases of acute myocardial infarction were analyzed.Results Atypical ECGs included non-ST-segment elevation myocardial infarction （10 cases） ; early period of AMI （4 cases） ; multiple times of myocardial infarction at same part （2 cases） ; myocardial infarction with bundle branch block （6 cases） ; combined posterior myocardial infarction （2 cases） ; small area of myocardial infarction（6 cases） and records of mistaken-lead,and U-wave inversion （2 cases）.Atypical electrocardiogram changes included significant and persistent ST segment depression and T wave inversion,T wave height,poor R wave progression or reverse incremental,bundle branch block cover Mi graphics,and U wave inversion.Conclusion The dynamic changes of ECG and myocardial enzyme should be tracked for patients with atypical electrocardiogram of myocardial infarction,so that timely diagnosis can be made,and avoid misdiagnosis and missed diagnosis.