Grollier G, Scanu P, Gofard M, Lognoné T, Valette B, Bureau G, Commeau P, Potier J C
Service de soins intensifs de cardiologie, CHU Côte de Nacre, Caen.
Arch Mal Coeur Vaiss. 1992 Jan;85(1):67-75.
ST segment elevation in the anterior precordial chest leads may be observed in some cases of right ventricular infarction alone or associated with left ventricular inferior wall infarction. Six out of 700 patients admitted to our Coronary Care Unit over a 2 year period had right ventricular infarction with these electrocardiographic changes. In three cases, isolated right ventricular infarction was due to occlusion of a right marginal artery (N = 2) or of a small right coronary artery (N = 1) which only vascularised the right ventricle. In 2 cases, right ventricular infarction was associated with a recent or chronic left ventricular inferior wall infarct. This type of ST segment elevation may suggest a left ventricular anterior wall infarct especially when there are no changes in the inferior leads, as was the case in our first patient. However, the dome-like appearance of the ST segment, the reduction in amplitude of ST elevation from V2 to V5, the progressive regression of the ST changes without the appearance of Q waves, are more suggestive of the diagnosis of right ventricular infarction. In addition, normal left ventricular dilatation on echocardiographic examination rapidly confirms the diagnosis.
在前壁胸前导联出现ST段抬高，可见于部分单纯右心室梗死病例或合并左心室下壁梗死的情况。在两年期间入住我们冠心病监护病房的700例患者中，有6例出现了伴有这些心电图改变的右心室梗死。3例单纯右心室梗死是由于右缘支动脉（2例）或仅为右心室供血的一小支右冠状动脉（1例）闭塞所致。2例右心室梗死合并近期或陈旧性左心室下壁梗死。这种类型的ST段抬高可能提示左心室前壁梗死，尤其是在下壁导联无变化时，如我们的首例患者。然而，ST段呈圆顶状外观、ST段抬高幅度从V2至V5逐渐降低、ST段改变逐渐消退且无Q波出现，更提示右心室梗死的诊断。此外，超声心动图检查显示左心室正常扩张可迅速确诊。
