ST段抬高型心肌梗死中左前降支近端闭塞的心电图模式可能会因三支冠状动脉疾病而改变。
Electrocardiographic patterns of proximal left anterior descending artery occlusion in ST-elevation myocardial infarction may be modified by 3-vessel coronary artery disease.
作者信息
Neeland Ian J, Sulistio Melanie S, Stoller Douglas A, de Lemos James A, Atkins James M, McGuire Darren K
机构信息
Donald W Reynolds Cardiovascular Clinical Research Center, Dallas, TX, USA.
出版信息
J Electrocardiol. 2012 May-Jun;45(3):272-6. doi: 10.1016/j.jelectrocard.2011.12.003. Epub 2012 Jan 14.
BACKGROUND
The electrocardiographic (ECG) pattern of ST-segment deviation in myocardial infarction is integral to the proper assessment of the location, extent, and functional significance of the infarct but may be modified by the underlying coronary artery anatomy.
METHODS
We describe the ECG findings in 2 cases of proximal left anterior descending (LAD) artery occlusion in ST-elevation myocardial infarction (STEMI) associated with 3-vessel coronary artery disease.
RESULTS
Both patients had atypical ECG patterns of ST-segment elevation in leads V(2), I, and aVL and ST-segment depression with positive T waves suggestive of extensive subendocardial ischemia in leads II, III, aVF, and V(3) through V(6); acute proximal LAD occlusion and concomitant 3-vessel coronary artery disease were observed angiographically.
CONCLUSION
Electrocardiographic changes in proximal LAD STEMI may be modified by the presence of significant atherosclerotic disease elsewhere in the coronary vasculature. Recognition of this ECG pattern may aid the clinician in the rapid identification of high-risk STEMI.
背景
心肌梗死时ST段偏移的心电图模式对于正确评估梗死的部位、范围及功能意义至关重要，但可能会受到潜在冠状动脉解剖结构的影响。
方法
我们描述了2例ST段抬高型心肌梗死（STEMI）伴三支冠状动脉疾病患者近端左前降支（LAD）动脉闭塞时的心电图表现。
结果
两名患者均有非典型心电图模式，V（2）、I及aVL导联ST段抬高，II、III、aVF及V（3）至V（6）导联ST段压低伴T波直立，提示广泛心内膜下缺血；血管造影显示为急性近端LAD闭塞并伴有三支冠状动脉疾病。
结论
近端LAD STEMI的心电图改变可能会因冠状动脉血管系统其他部位存在显著动脉粥样硬化疾病而受到影响。认识这种心电图模式可能有助于临床医生快速识别高危STEMI。
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