Kanemoto N, Atsumi H
Department of Internal Medicine, School of Medicine, Tokai University, Kanagawa, Japan.
Tokai J Exp Clin Med. 1990 Mar;15(1):1-4.
We describe here a 87-year-old male who came to the emergency room with the chief complaints of dyspnea and chest pain. His electrocardiogram showed a wide QRS tachycardia with a heart rate of 140 beats/min, a left bundle branch block pattern and low voltage in leads I, aVL, V5 and V6. A long strip showed a premature ventricular complex, and the sinus beat just after the extrasystole showed P waves which were positive in leads I, II, III and a VF similar in shape to those in sinus rhythm. Therefore, a diagnosis of sinus tachycardia with tachycardia dependent left bundle branch block was made. The low voltage in the left lateral leads was ascribed to pneumothorax of the left lung. When a wide QRS tachycardia is encountered in an emergency situation, marked sinus tachycardia with coexistent bundle branch block or aberrant ventricular conduction should be taken into consideration.
我们在此描述一位87岁男性，他因呼吸困难和胸痛为主诉前来急诊室。他的心电图显示宽QRS心动过速，心率为140次/分钟，呈左束支传导阻滞图形，I、aVL、V5和V6导联电压降低。长条心电图显示室性早搏，早搏后的窦性搏动显示I、II、III和aVF导联P波阳性，形态与窦性心律时相似。因此，诊断为窦性心动过速伴心动过速依赖性左束支传导阻滞。左侧导联电压降低归因于左肺气胸。在紧急情况下遇到宽QRS心动过速时，应考虑显著窦性心动过速合并束支传导阻滞或心室差异性传导。
