QRS波增宽的心肌梗塞患者预后不良(附31例分析)

An ominous prognosis in patients with CHD associated with QRS prolongation

本文报告31例心肌梗塞伴QRS波增宽患者的予后,其中急性心梗13例、陈旧心梗18例,均有较频繁的心绞痛。心电图表现为I、aVL、V_5、V_6或Ⅱ、Ⅲ、aVF导联上q和s波变小消失,R波增宽有挫折并振幅渐减小。本组QRS增宽≥30％10例,≥50％19例,≥100％2例;死亡29例。急性心梗前后出现QRS增宽的13例全部死亡。本组患者心衰和猝死率高,说明心梗伴QRS增宽≥30％者预后险恶。

Prognosis in 31 patients (29 males, 2 females, mean age 68 years) with coronary heart disease (CHD) associaled with QRS prolongation were evaluated. All patients freguently had attacks of spontaneous angina pectoris. Prolongation of QRS duration before or during acute myocardial infarction (AMI) was found in 12 patients during angina pectoris episodes, in 18 with old myocardial infarction and in one with unstable angina pectoris. The electrocardiogram also showed disappearance or decrease of q and S wave with prolongation of QRS duration in leads Ⅰ, avL, V5, V6 or Ⅱ, Ⅲ, avF. The QRS prolongation was longer than 30% of the preceding QRS in 10 patients, ≥50% in 19 patients, ≥100% in 2 patients. 27 of the 31 patients ended in cardiac death. Other 4 patients were survival. Patients in whom QRS prolongation developed before or during AMI died, 11 of these 12 patients died within first week after AMI. The results show that the prognosis was ominous in the patients with CHO associated with ≥30% of QRS prolongation. Finally, the mechanism of QRS prolongation is discussed briefly.