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本文报告一例左前分支阻滞(LAH)完全掩盖右束支阻滞(RBBB)的病例。患者女性,78岁。因严重胸骨下疼痛而收入冠心病监护病房。既往有二尖瓣狭窄伴心房纤颤。临床表现及酶学检查符合典型的急性心肌梗塞(AMI)。入院时ECG示心房纤颤,心室率75次/分,心电轴-30°,QRS波群0.08秒,V 1至V4导联有异常的QS波及ST段抬高,诊断为前壁Ml。40小时后出现LAH伴QRS 波群增宽。ECG示电轴左倾-80°,QRS波群0.12秒,V2至V4导联由QS型转为grS型,aVR及V6导联有R波和S波,V 1、V2导联QRS波群有终未切迹。QRS波群增宽以及V1、V2导联的QRS波切迹提示为LAH合并隐匿性R BBB。V1、V2高一肋间记录到的ECG则显示出RBBB的终末R波图形。过5小时后ECG完全显示RBBB伴LAH的图形,
This article reports a case of complete obstruction of right bundle branch block (RBBB) with left anterior branch block (LAH). Female patient, 78 years old. Due to severe chest pain and income coronary care unit. Previously mitral stenosis with atrial fibrillation. Clinical manifestations and enzymatic examination consistent with typical acute myocardial infarction (AMI). Admission atrial fibrillation showed atrial fibrillation, ventricular rate 75 beats / min, ECG axis -30 °, QRS complex 0.08 seconds, V 1 to V4 leads abnormal QS waves and ST segment elevation, the diagnosis of the anterior wall Ml. After 40 hours there was a widening of the LAH with QRS complex. ECG axis left tilt -80 °, QRS wave group 0.12 seconds, V2 to V4 leads from the QS type to grS type, aVR and V6 lead with R wave and S wave, V1, V2 lead QRS wave group End not cut. The widening of the QRS complex, as well as the QRS wave notches in leads V1 and V2, suggest the incorporation of occult R BBB for LAH. The ECG recorded at V1 and V2 intercostals showed the terminal R wave pattern of RBBB. After 5 hours, the ECG completely shows the pattern of RBBB with LAH,