Khalil Siddiq, Kamal Amjad, Ahmed Shakeel
Department of Cardiology, Almana General Hospital, Jubail, 31961 Saudi Arabia.
J Electrocardiol. 2005 Oct;38(4):412-3. doi: 10.1016/j.jelectrocard.2005.06.036.
We report a case of 54-year-old man who presented to hospital with severe prolonged retrosternal chest pain of anginal nature. Electrocardiogram taken by his general practitioner showed minimal ST elevation in chest leads V1 and V2; there was also marked right axis deviation of P wave (negative in lead I and aVL) and of QRS complexes, together with low voltage in precordial leads V4 through V6 suggestive of dextrocardia. Repeat electrocardiogram with chest and limb leads reversed showed widespread, significant ST elevation in lead I, aVL, and V1 through V5 in keeping with extensive acute anterior myocardial infarction (MI). High cardiac enzymes and troponin level provided further confirmation. The extent of MI in such patients may be underestimated unless dextrocardia is timely recognized and leads reversed. We recommend that for patients with dextrocardia and situs inversus presenting with MI, both chest and limb leads be reversed to reveal the true extent of the infracted area.
我们报告一例54岁男性患者，因严重的、持续时间较长的胸骨后心绞痛样胸痛入院。其全科医生所做的心电图显示胸导联V1和V2有轻微ST段抬高；P波和QRS波群也有明显的电轴右偏（I导联和aVL导联为负向），胸前导联V4至V6电压降低，提示右位心。将胸导联和肢体导联反接后重复心电图检查，结果显示I导联、aVL导联以及V1至V5导联广泛、显著的ST段抬高，符合广泛急性前壁心肌梗死。高心肌酶和肌钙蛋白水平进一步证实了诊断。除非及时识别右位心并将导联反接，否则此类患者的心肌梗死范围可能被低估。我们建议，对于右位心和内脏反位且发生心肌梗死的患者，应将胸导联和肢体导联都反接，以揭示梗死区域的真实范围。
