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[急性下壁心肌梗死掩盖J波综合征。基于四项观察]

[Acute inferior myocardial infarction masking the J wave syndrome. Based on four observations].

作者信息

Ortega Carnicer J

机构信息

Servicio de Medicina Intensiva, Hospital General de Ciudad Real, España.

出版信息

Med Intensiva. 2008 Jan-Feb;32(1):48-53. doi: 10.1016/s0210-5691(08)70902-1.

Abstract

The J wave syndrome is characterized by a prominent J wave accompanied by ST-segment elevation in the absence of structural heart disease. It includes the benign early repolarization syndrome, the highly arrhythmogenic Brugada syndrome and idiopathic ventricular fibrillation. Although acute coronary syndromes are one of the leading causes of ST-segment deviation, no clinical reports that specifically describe the modulating effects of an ischemic injury current on the ECG manifestations of the J wave syndrome have been found. This report describes four cases of patients with acute inferior ST-segment elevation myocardial infarction who had J wave (or negative deplacement of the J point) and ST-segment depression in the right precordial leads. Later, these precordial ECG alterations disappeared and were progressively replaced by prominent J (R') waves and anterior ST-segment elevations, suggesting the presence of a J wave syndrome. In conclusion, the J wave syndrome may be obscured by an acute inferior myocardial infarction with concomitant ST-segment depression in the right precordial leads. In such circumstances, early detection of the J wave (or depressed J point) may be used as ECG marker of the early repolarization syndrome or Brugada syndrome.

摘要

J波综合征的特征是在无结构性心脏病的情况下出现显著的J波并伴有ST段抬高。它包括良性早期复极综合征、高度致心律失常性Brugada综合征和特发性室颤。虽然急性冠状动脉综合征是ST段偏移的主要原因之一,但尚未发现专门描述缺血性损伤电流对J波综合征心电图表现调节作用的临床报告。本报告描述了4例急性下壁ST段抬高型心肌梗死患者,他们在右胸前导联出现J波(或J点下移)和ST段压低。后来,这些胸前导联心电图改变消失,并逐渐被显著的J(R')波和前壁ST段抬高所取代,提示存在J波综合征。总之,J波综合征可能被伴有右胸前导联ST段压低的急性下壁心肌梗死所掩盖。在这种情况下,早期检测到J波(或压低的J点)可作为早期复极综合征或Brugada综合征的心电图标志物。

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