心电图V1导联呈大R波的鉴别诊断

Prominent R Wave in Lead V1:Electrocardiographic Differential Diagnosis

目的 通过V1导联呈大R波(R/S>1)鉴别后壁心肌梗死、右心室肥大、左心室或室间隔增厚.方法 回顾分析57例V1导联R/S>1的患者心电图及心脏超声,按照其心脏超声结果 ,将57例患者分成5组,第1组为后壁心肌梗死,共10例;第2组为右心室肥大,共4例;第3组为左心室或室间隔增厚,共11例;第4组为左房增大或左室松弛性下降,共20例;第5组为心脏瓣膜轻度返流或正常超声心动图表现,共12例.分析第3组、第4组及第5组之间异常q/Q波发生率的差异.结果 (1)第1组患者的心电图共同特征为V1-V3导联R/S>1及V1-V3导联T波直立,伴下壁、侧壁导联异常q/Q波或者胸前导联R波递增不良,伴或不伴V1-V3导联ST段压低;第2组患者的心电图共同特征为:V1导联R/S>1及V1导联P波正向波振幅增高,且出现电轴右偏及V1-V3导联T波倒置;第3组患者的心电图特征为V1导联R/S>1,8例(占72.3%)患者出现多导联异常q/Q波改变,9例(占81.8%)患者出现复极改变(包括ST段、T波或ST-T改变);第4组患者的心电图特征为V1导联R/S>1,10例(占50.0%)患者出现复极改变,2例患者出现异常q/Q波;第5组患者的心电图特征为V1导联R/S>1,均无异常q/Q波及ST段改变,4例患者出现T波改变.(2)第3组患者的异常q/Q波发生率高于第4组(χ2=10.069,P=0.002)及第5组患者(χ2=10.368,P=0.001),第4组与第5组的异常q/Q波的发生率差异无统计学意义(P=0.516).结论 心电图V1导联R/S>1对患者的后壁心肌梗死、右室肥大、左室肥大及室间隔肥厚有一定的鉴别价值.

Objective To distinguish posterior myocardial infarction,right ventricular hypertrophy and left ventricular or interventricular septum hypertrophy by prominent R wave(R/S>1)in lead VI.Methods The electrocardiograms(ECGs)of 57 patients combined with their ultrasonic cardiograms(UCGs)were reviewed from the First Affiliated Hospital of Soochow University.The subjects were divided into five groups according to their UCGs.The first group was posterior myocardial infarction and had 10 cases.The second group was right ventricular hypertrophy and had 4 cases.The third group was left ventricular or interventricular septum hypertrophy and had 11 cases.The fourth group was left atrial enlargement or left ventricular relaxation decreasing and had 20 cases.The fifth group was normal UCG or the cardiac valve was slightly recirculated and the cases were 12.Occurrence rate of abnormal q/Q wave in the last three groups were analyzed.Results 1.The common characteristic of the first group was R/S>1 in lead V1-V3,T wave was upright in lead V1-V3 and abnormal q/Q wave in inferior and lateral leads or poor R wave progression in chest leads,with or without ST segment depression in leads V1-V3.The common characteristic of the second group was R/S>1 and the amplitude of positive P wave of lead VI increased,right axis deviated and T wave was inverted in lead VI.The characteristic of the third group was R/S>1 in lead VI,with 8 cases(72.3%)having abnormal q/Q wave in many leads and 9 patients(81.8%)having repolarization change(referred to ST segment,T wave,or ST-T change).The characteristic of the fourth group was R/S>1 in lead VI,with 10 patients(50.0%)having repolarization change and 2 patients having abnormal q/Q wave.The characteristic of the fifth group was R/S>1 in lead VI,with T wave change in 4 cases,without abnormal q/Q wave and ST change.2.The occurrence rate of abnormal q/Q wave of the third group was higher than the fourth group(x 2=10.069,P=0.002)and the fifth group(x 2=10.36&P=0.001).The occurrence rate of abnormal q/Q wave was similar in the fourth and fifth group(P=0.516).Conclusion We can distinguish posterior myocardial infarction,right ventricular hypertrophy and left ventricular or interventricular septum hypertrophy by R/S>1 in lead V1.