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目的证实用标准12导联心电图中Ⅲ导联ST段变化幅度与Ⅲ导联ST段变化幅度的比值≥1诊断下壁合并右室心肌梗死的临床诊断价值。方法对21例根据临床表现,并经冠脉造影证实的急性下壁合并右心室心肌梗死的Ⅲ导联ST段变化幅度与Ⅱ导联ST段变化幅度的比值,评价该比值≥1在急性下壁合并右心室心肌梗死的诊断价值。结果 21例患者的临床症状除有典型的下壁心肌梗死表现外,还有低血压甚至心源性休克等右心室衰竭的症状,经冠状动脉造影证实符合下壁合并右室心肌梗死的诊断。19例心电图中Ⅲ导联ST段变化幅度与Ⅱ导联ST段变化幅度的比值>1;其中16例右胸导联V3R～V6R导联ST段变化幅度>0.1mV,3例ST段抬高但幅度<0.1mV。2例心电图中Ⅲ导联ST段变化幅度与Ⅱ导联ST段变化幅度的比值:1;右胸导联V3R-V6R导联中QRS呈qr型,ST段抬高但幅度<0.1mV。结论用常规12导联心电图中m导联ST段变化幅度与Ⅱ导联ST段变化幅度的比值≥1,结合临床表现、心肌酶谱的变化以及右胸导联心电图的变化对诊断下壁合并右室心肌梗死具有较好的临床应用价值。
Objective To confirm the clinical diagnostic value of the ratio of the change of ST segment of lead Ⅲ to the change of ST segment of lead Ⅲ ≥1 in diagnosis of inferior wall combined with right ventricular myocardial infarction by standard 12-lead electrocardiogram. Methods 21 cases of acute inferior wall combined with right ventricular myocardial infarction confirmed by coronary angiography based on the ST segment of lead Ⅱ and the change of Ⅱ lead ST segment amplitude ratio of the ratio of evaluation of the ratio ≥ 1 in acute Diagnostic Value of Wall Combined Right Ventricular Myocardial Infarction. Results In addition to the typical inferior wall myocardial infarction, 21 patients had symptoms of right ventricular failure, such as hypotension and cardiogenic shock. Coronary angiography confirmed the diagnosis of inferior wall combined with right ventricular myocardial infarction. 19 cases of electrocardiogram Ⅲ lead ST segment changes in amplitude and Ⅱ lead ST segment changes in amplitude ratio> 1; of which 16 cases of right chest lead V3R ~ V6R lead ST segment amplitude> 0.1mV, ST-segment elevation in 3 cases But the magnitude of <0.1mV. In 2 cases, the ratio of ST segment change in lead Ⅲ to the change of ST segment in lead Ⅱ was 1; QRS in right lead chest V3R-V6R was qr, and ST segment elevation was only <0.1mV. CONCLUSION: The ratio of the ST segment of m lead in the conventional 12-lead electrocardiogram to the change of the ST segment in the lead II ≥ 1, combined with the changes of the clinical manifestations, the changes of myocardial enzymes and the changes of right chest lead ECG, Right ventricular myocardial infarction has a good clinical value.