Rashduni David L, Tannenbaum Alan K
UMDNJ-Robert Wood Johnson Medical School, Division of Cardiovascular Diseases and Hypertension, USA.
N J Med. 2003 Nov;100(11):35-7.
We performed twelve lead electrocardiograms(ECG) and right precordial leads on twenty-two consecutive patients with first inferior wall acute myocardial infarction (MI) diagnosed by classical Q waves and elevation of cardiac enzymes. The presence of right ventricular MI was established by either technetium 99 (TC-99) pyrophosphate scanning or 2-dimensional (2-D) echocardiography by observers unrelated to the study and not aware of the electrocardiographic findings. In patients with established right ventricular MI (n = 15/22), ST segment elevation > or = 0.1 mV in lead V4R placed in the right precordial lead position had 91% (10/11) sensitivity in diagnosing right ventricular MI. ST segment depression in lead AVL > or = 0.1 mV had 100% sensitivity in diagnosing right ventricular MI (15/15). In the seven patients without right ventricular infarction, the absence of ST segment elevation in lead V4R had 100% specificity (7/7), while the absence of ST segment depression in lead AVL had 57% specificity (4/7) in excluding right ventricular infarction. The data indicate that in the presence of inferior wall MI, ST segment depression in lead AVL is a sensitive, but not very specific sign of right ventricular MI. Therefore, its presence in patients with inferior wall MI should lead to further investigations to diagnose or exclude right ventricular MI.
我们对连续22例经典型Q波和心肌酶升高确诊为首次下壁急性心肌梗死（MI）的患者进行了12导联心电图（ECG）及右胸前导联检查。右心室MI的诊断由与本研究无关且不知心电图结果的观察者通过锝99（TC - 99）焦磷酸盐扫描或二维（2 - D）超声心动图确定。在确诊为右心室MI的患者（n = 15/22）中，位于右胸前导联位置的V4R导联ST段抬高≥0.1 mV对诊断右心室MI的敏感性为91%（10/11）。AVL导联ST段压低≥0.1 mV对诊断右心室MI的敏感性为100%（15/15）。在7例无右心室梗死的患者中，V4R导联无ST段抬高对排除右心室梗死的特异性为100%（7/7），而AVL导联无ST段压低对排除右心室梗死的特异性为57%（4/7）。数据表明，在下壁MI患者中，AVL导联ST段压低是右心室MI的一个敏感但特异性不强的体征。因此，下壁MI患者出现该体征应进一步检查以诊断或排除右心室MI。
