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目的:证实用标准12导联心电图中III导联ST段抬高变化幅度与Ⅱ导联ST段抬高变化幅度的比值≥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段抬高变化幅度与Ⅱ导联ST段抬高变化幅度的比值,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段抬高变化幅度与Ⅱ导联ST段抬高变化幅度的比值>1;其中16例右胸导联V3R～V6R导联ST段抬高变化幅度>0.1mV,3例ST段抬高但幅度<0.1mV。2例心电图中Ⅲ导联ST段抬高变化幅度与Ⅱ导联ST段抬高变化幅度的比值=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III导联ST段抬高变化幅度与Ⅱ导联ST段抬高变化幅度的比值≥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 ST segment elevation in the lead III of the standard 12-lead electrocardiogram to the change of the ST segment elevation in the lead II ≥ 1 to diagnose the right inferior wall myocardial infarction. Methods: The ratio of ST segment elevation in lead Ⅲ and ST segment elevation in lead Ⅱ was calculated based on the clinical manifestations and confirmed by coronary angiography in 21 patients with right inferior wall myocardial infarction Diagnostic Value of ≥1 in Acute Right Wall Combined with Right Ventricular Myocardial Infarction. Results: In addition to the typical clinical manifestations of inferior wall myocardial infarction in 21 patients, there were symptoms of right ventricular failure such as hypotension and cardiogenic shock. Coronary arteriography confirmed the diagnosis of inferior wall combined with right ventricular myocardial infarction . In 19 cases, the ratio of ST segment elevation in lead Ⅲ to ST segment elevation in lead Ⅱ was> 1, and the amplitude of ST segment elevation in V3R to V6R lead was more than 0.1 mV in 16 cases. 3 cases of ST elevation but amplitude <0.1mV. 2 cases of electrocardiogram Ⅲ lead ST segment elevation amplitude and Ⅱ lead ST segment elevation change rate ratio = 1; right chest lead V3R ~ V6R lead QRr was qr type, ST segment elevation but amplitude < 0.1mV. CONCLUSIONS: The ratio of the ST segment elevation in the lead III to the ST segment elevation in the lead II ≥ 1 in the conventional 12-lead electrocardiogram, combined with clinical manifestations, changes of myocardial zymogram and changes of right chest lead electrocardiogram Right lower wall diagnosed with right ventricular myocardial infarction has a good clinical value.