左冠状动脉回旋支急性闭塞的心电图特点

The character of ECG in obliteration of circumflex branch of left coronary artery without abnormally directed T-wave and ST-segment elevation

目的 评价左冠状动脉回旋支急性闭塞超急期心电图特征及演变规律。方法 选择 16例发病 6 h以内入院 ,经行紧急冠状动脉造影 ,确诊为左冠状动脉回旋支急性闭塞的心肌梗塞病人 ,进行 6 h以内 ,12 h以后 ,2 4h以后 ,7d后 ,14d后的心电图观察。结果 超急期的心电图特点 :1V3 - V5导联 ST段下移约 0 .5～ 1mm。 2 V2 - V3 导联 u波抬高约 1m m,与 T波相比 ,T/u比值减小。动态观察 :12 h以后 1V1 - V2 导联 R波逐渐增高 ,S波逐渐变浅 ,R/S≥ 1。 2下移的 ST段 ,从发病至 2 0 h很快恢复到基线。 3V1 - V2 导联 T波抬高 ,u波降低 ,T/u比值增大。 4V6导联的 R波逐渐减低 ,提示单纯后壁梗死。结论 发病 6 h以内怀疑超急期心肌梗塞时 ,若有 ST- T变化 ,右胸导联有大 u波 ,T/u比值减小 ,应为鉴别有无左冠状动脉回旋支闭塞所致正后壁心肌梗塞的条件之一。

Objective To evaluate the character and variation of ECG during the acute phase of obliteration in circumflex branch of left coronary artery.Methods Coronary arteriography was performed in 16 patients whose circumflex branch of left coronary artery was obliterated. The entire patient was hospitalized within 6 hours of illness. ECG was observed at the following periods(within 6 hours?12 hours?24 hours?7 days after procedure).Results The character of acute phase :①ST-segment depressed about 0.5~1 mm in lead V 3-V 5.②U-wave elevated about 1 mm and the value of T/u was decreased. Dynamic observing: 12 hours later, ①R-wave was on the increase and S-wave was on the decrease in lead V 1-V 2;R/S≥1. ②ST-segment quickly returned to baseline within 12 hours of illness.③T-wave elevated and R-wave decreased; T/u was increased.④The depression of R-wave in lead V 6 indicated simple infarct in posterior wall.Conclusions ST-T changes, augmented u-wave in right chest leads, decrease of T/u value might be useful in diagnosing posterior wall AMI caused by obliteration of circumflex branch of left coronary artery.