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束支传导阻滞可在心肌梗塞前已存在,或者由急性心肌梗塞所引起,两者在心电图上互相影响,致使心肌梗塞的诊断发生困难。病史摘要及心电图分析:患者男性,73岁,反复发作性胸骨后疼痛2年,呈压榨性,近2周加重,经休息或服硝酸甘油未能缓解。1982年10月13日疼痛尤甚伴血压降低而入院。过去有高血压史30余年,糖尿病2年,1980年12月13日心电图证实为完全性右束支阻滞(RBBB)。入院检查,血压100/60毫米汞柱,心率120次/分,心界向左下扩大,心音低,心尖区Ⅱ级收缩期杂音,两肺底少许湿罗音,CPK16.6单位,MB2.8单位,LDH1080单位,SGOT70单位,血糖293mg/dl。入院时心电图(见封三附图):各导联P波顺序出现,115次/分。ptfv_1=-0.072mms,反映左室舒张末期
Bundle branch block may have existed before myocardial infarction, or caused by acute myocardial infarction, the two affect each other on the ECG, resulting in the diagnosis of myocardial infarction difficult. Medical history summary and ECG analysis: Male patient, 73 years old, recurrent sternal pain for 2 years, was squeezed, nearly two weeks of exacerbation, resting or taking nitroglycerin failed to alleviate. On October 13, 1982, pain was especially associated with reduced blood pressure and admission. In the past more than 30 years of history of hypertension, diabetes 2 years, December 13, 1980 ECG confirmed complete right bundle branch block (RBBB). Admission examination, blood pressure 100/60 mm Hg, heart rate 120 beats / min, heart left to expand, low heart rate, apical systolic murmur, two lungs at the end a little wet rales, CPK16.6 units, MB2.8 Unit, LDH1080 unit, SGOT70 unit, blood sugar 293mg / dl. Admission electrocardiogram (see cover three photos): P lead wave appeared in the order, 115 beats / min. ptfv_1 = -0.072mms, reflecting left ventricular end-diastolic