Somers Michael P, Brady William J, Bateman Devin C, Mattu Amal, Perron Andrew D
Department of Emergency Medicine, University of Virginia Health Sciences Center, Charlottseville, VA 22908, USA.
Am J Emerg Med. 2003 Nov;21(7):563-73. doi: 10.1016/j.ajem.2003.08.008.
In the evaluation of the patient with chest pain, the 12-lead electro cardiogram is a less-than-(ECG) perfect indicator of acute myocardial infarction (AMI), particularly when used early in the course of the acute ischemic event; this relative insensitivity for AMI results from many different issues, including a less-than-optimal imaging of certain areas of the heart. It has been suggested that the sensitivity of the 12-lead ECG can be improved if 3 additional body surface leads are used in selected individuals. Acute posterior (PMI) and right ventricular myocardial infarctions are likely to be underdiagnosed, because the standard lead placement of the 12-lead ECG does not allow these areas to be assessed directly. Additional leads frequently used include leads V(8) and V(9), which image the posterior wall of the left ventricle, and lead V(4R), which reflects the status of the right ventricle. The standard ECG coupled with these additional leads constitutes the 15-lead ECG, the most frequently used additional lead ECG in clinical practice. The use of the additional leads might not only confirm the presence of AMI, but also provide a more accurate reflection of the true extent of myocardial damage.
在对胸痛患者进行评估时，12导联心电图（ECG）对于急性心肌梗死（AMI）而言并非完美指标，尤其是在急性缺血事件病程早期使用时；AMI的这种相对不敏感性源于许多不同问题，包括对心脏某些区域的成像欠佳。有人提出，在特定个体中使用另外3个体表导联可提高12导联ECG的敏感性。急性后壁心肌梗死（PMI）和右心室心肌梗死很可能未得到充分诊断，因为12导联ECG的标准导联放置方式无法直接评估这些区域。常用的额外导联包括V（8）和V（9）导联，它们用于对左心室后壁成像，以及V（4R）导联，其反映右心室状况。标准ECG加上这些额外导联构成了15导联ECG，这是临床实践中最常用的额外导联ECG。使用额外导联不仅可以确认AMI的存在，还能更准确地反映心肌损伤的真实程度。
