Smedema J P, Katjitae I, Reuter H, Burgess L, Louw V, Pretorius M, Doubell A F
Department of Internal Medicine, Cardiology Unit, Tygerberg Hospital, Western Cape, South Africa.
Cardiovasc J S Afr. 2001 Feb-Mar;12(1):31-4.
This study is part of an ongoing initiative started in 1995 to investigate the therapeutic efficacy of adjuvant corticosteroids in the management of tuberculosis (TB) pericarditis. In this retrospective, descriptive study we describe the changes found on the 12-lead electrocardiogram (ECG) in patients with TB pericarditis, with and without cardiac tamponade. We determined the diagnostic accuracy of ECG parameters for cardiac tamponade.
All patients referred to our department with echocardiographically confirmed large pericardial effusions underwent a thorough clinical assessment followed by pericardiocentesis and drainage using an indwelling pigtail catheter. The amount of drained effusion was measured, and fluid was sent for diagnostic assessment. Patients were grouped into those with or without cardiac tamponade. The following ECG parameters were assessed: rate, rhythm, microvoltage, electrical alternans, PR segment and ST segment abnormalities.
Of the 157 patients assessed, 88 were diagnosed with TB pericarditis All had abnormal ECGs and 83% had changes of chronic pericarditis. Microvoltage in the extremity and/or precordial leads correlated with the presence of large effusions (> 750 ml). None of the studied parameters correlated with the presence of cardiac tamponade.
Twelve-lead ECG is of supportive but not diagnostic value in cardiac tamponade. The presence of microvoltage suggests the presence of a large effusion. The absence of microvoltage makes the presence of cardiac tamponade unlikely.
本研究是始于1995年的一项正在进行的项目的一部分，旨在调查辅助性皮质类固醇在结核性心包炎治疗中的疗效。在这项回顾性描述性研究中，我们描述了有或没有心脏压塞的结核性心包炎患者12导联心电图（ECG）的变化。我们确定了ECG参数对心脏压塞的诊断准确性。
所有经超声心动图证实有大量心包积液并转诊至我院的患者均接受了全面的临床评估，随后使用留置猪尾导管进行心包穿刺引流。测量引流的积液量，并将液体送去进行诊断评估。患者被分为有或没有心脏压塞两组。评估以下ECG参数：心率、心律、微电压、电交替、PR段和ST段异常。
在评估的157例患者中，88例被诊断为结核性心包炎。所有患者的ECG均异常，83%有慢性心包炎的改变。肢体导联和/或胸前导联的微电压与大量积液（>750 ml）的存在相关。所研究的参数均与心脏压塞的存在无关。
12导联ECG对心脏压塞有支持作用，但无诊断价值。微电压的存在提示有大量积液。无微电压则不太可能存在心脏压塞。
