Ortega Carnicer J
Servicio de Medicina Intensiva, Hospital General de Ciudad Real, Ciudad Real, España.
Med Intensiva. 2006 May;30(4):143-8. doi: 10.1016/s0210-5691(06)74494-1.
To describe the patients with ischemic chest pain and simultaneous ST-segment elevation in the inferior and right precordial leads. MATERIAL AND METHODS.
Series of cases.
an adult, Intensive Care Service with 16 beds, with no hemodynamic service, for the management of coronary and polyvalent patients.
we studied 10 patients with acute coronary syndrome who had: a) a ST-segment elevation > or = 1 mm in two or more contiguous leads in the inferior and right precordial leads, b) a resolution of the ST-segment elevation and/or the appearance of Q waves or decrease of the R wave amplitude after the disappearance of the angina and c) a coronary angiographic study.
There were 9 men and 1 woman, with an average age of 62.6 years. Two patients had a background of inferior myocardial infarction. Nine patients received thrombolytic treatment after 122.2 +/- 93.9 minutes of the pain onset. Leads III and V3 showed the greatest elevations of ST segment. Serum levels of creatine kinase were normal in 3 cases and significantly elevated (> 1700 U/L) in six. The ECG evolved to normality in 2 cases and it showed inferior Q waves in 5 patients, and negative T waves in 3 patients. Three patients had no complications, three cases had cardiac blocks and three patients had ventricular tachycardias. The coronary arteriography was normal in 2 patients; three patients showed a proximal stenosis in the right coronary artery and five patients had two or more stenotic coronary arteries. Three patients were diagnosed of unstable angina, one patient was diagnosed of transient apical cardiomyopathy, 4 patients had an acute inferior myocardial infarction with right ventricular extension and 2 patients had a myocardial infarction without anterior Q wave. All the patients survived.
Most of the patients with acute coronary syndrome associated with simultaneous SST elevation in inferior and right precordial leads had multivessel coronary disease and all patients with only one coronary vessel involved had right ventricular infarction secondary to severe proximal lesion of the right coronary artery.
描述下壁和右胸前导联出现缺血性胸痛并伴有ST段抬高的患者情况。材料与方法。
病例系列研究。
一家拥有16张床位的成人重症监护病房，没有血流动力学监测服务，用于管理冠心病和多脏器疾病患者。
我们研究了10例急性冠脉综合征患者，这些患者具备以下情况：a）下壁和右胸前导联两个或更多相邻导联ST段抬高≥1mm；b）心绞痛消失后ST段抬高消退和/或出现Q波或R波振幅降低；c）进行了冠状动脉造影研究。
9名男性和1名女性，平均年龄62.6岁。2例患者有下壁心肌梗死病史。9例患者在疼痛发作122.2±93.9分钟后接受了溶栓治疗。Ⅲ导联和V3导联ST段抬高最明显。3例患者肌酸激酶血清水平正常，6例显著升高（>1700U/L）。2例患者心电图恢复正常，5例患者出现下壁Q波，3例患者出现T波倒置。3例患者无并发症，3例患者出现心脏传导阻滞，3例患者出现室性心动过速。2例患者冠状动脉造影正常；3例患者右冠状动脉近端狭窄，5例患者有两条或更多冠状动脉狭窄。3例患者被诊断为不稳定型心绞痛，1例患者被诊断为短暂性心尖心肌病，4例患者为急性下壁心肌梗死伴右心室扩展，2例患者为无前壁Q波的心肌梗死。所有患者均存活。
大多数下壁和右胸前导联同时出现ST段抬高的急性冠脉综合征患者患有多支冠状动脉疾病，所有仅累及一支冠状动脉的患者均为右冠状动脉严重近端病变继发的右心室梗死。
