Castro P, Corbalán R, Garcés E, Kunstmann S, Howard M, Canto J
Departamento de Enfermedades Cardiovasculares, Hospital Clínico Universidad Católica, Santiago de Chile.
Rev Med Chil. 1992 Nov;120(11):1241-6.
Early EKG changes may contribute to predict the site of coronary artery occlusion during acute inferior myocardial infarction (MI). Its interpretation is relevant to therapeutic clinical decisions. We have prospectively evaluated early EKG changes of 40 consecutive patients with acute inferior MI and correlated them with the site and location of the coronary artery culprit lesion. Proximal right coronary artery occlusion was characterized by negative ST-T wave changes in leads D1 and aVL and ST segment elevation in leads D3 > D2. However the most distinctive EKG pattern of proximal right coronary artery occlusion was ST segment elevation with positive T wave in V4R (specificity 96%, predictive value 89%, p < 0.001). Distal right coronary artery occlusion was characterized by a positive T wave without ST segment elevation in V4R. Finally circumflex coronary artery occlusion was defined by a positive R/S > 1 relationship in V1, ST segment elevation in V5 and V6. Again lead V4R with flat or negative ST-T wave morphology had the highest predictive value for circumflex coronary artery occlusion (100%). Thus early EKG changes may contribute to precise the site and location of coronary artery occlusion and may help to implement clinical therapeutic strategies in patient with inferior MI. Right precordial leads are most useful in the EKG interpretation of inferior MI.
早期心电图改变可能有助于预测急性下壁心肌梗死（MI）期间冠状动脉闭塞的部位。其解读与临床治疗决策相关。我们前瞻性评估了40例连续急性下壁MI患者的早期心电图改变，并将其与冠状动脉罪犯病变的部位和位置相关联。右冠状动脉近端闭塞的特征是导联D1和aVL出现ST-T波倒置，导联D3的ST段抬高大于D2。然而，右冠状动脉近端闭塞最具特征性的心电图表现是V4R导联ST段抬高伴T波直立（特异性96%，预测值89%，p<0.001）。右冠状动脉远端闭塞的特征是V4R导联T波直立但无ST段抬高。最后，回旋支冠状动脉闭塞由V1导联R/S>1关系阳性、V5和V6导联ST段抬高定义。同样，V4R导联ST-T波形态平坦或倒置对回旋支冠状动脉闭塞具有最高预测价值（100%）。因此，早期心电图改变可能有助于明确冠状动脉闭塞的部位和位置，并可能有助于对下壁MI患者实施临床治疗策略。右胸前导联在解读下壁MI的心电图中最有用。
