Woo K S
Department of Medicine, Chinese University of Hong Kong.
Int J Cardiol. 1990 Mar;26(3):325-34. doi: 10.1016/0167-5273(90)90090-r.
In order to delineate the conduction defects complicating acute myocardial infarction in the Chinese, 636 Chinese patients admitted into one of the three medical units of a general hospital in Hong Kong in the period 1973-80 were reviewed. A relatively high incidence of conduction defects was observed, including atrioventricular block (11.3%), right bundle branch block (12.7%) and left bundle branch block (3.3%). Right bundle branch block (whether isolated or combined with left fascicular block) and atrioventricular block complicating anterior Q-wave infarction were ominous, with a high incidence of pump failure, cardiogenic shock and cardiac arrhythmias. These are markers of massive infarction. Atrioventricular and bundle branch blocks complicating inferior Q-wave infarction were benign. Left bundle branch block appeared to be a more chronic lesion, with moderate mortality, and isolated left anterior hemiblock did not adversely affect the short-term outcome. These results conform well to the patterns seen in Western series. The high incidence of conduction defects, in particular right bundle branch block and atrioventricular block complicating anteroseptal infarction, indicates a more serious clinical spectrum of acute myocardial infarction in the Chinese, and could have contributed to a higher hospital mortality in the Chinese series.
为了描述并发急性心肌梗死的传导缺陷在中国人群中的情况，我们回顾了1973年至1980年间入住香港一家综合医院三个医疗单元之一的636例中国患者。观察到传导缺陷的发生率相对较高，包括房室传导阻滞（11.3%）、右束支传导阻滞（12.7%）和左束支传导阻滞（3.3%）。右束支传导阻滞（无论是孤立的还是合并左束支分支阻滞）以及并发前壁Q波梗死的房室传导阻滞预后不佳，泵衰竭、心源性休克和心律失常的发生率很高。这些是大面积梗死的标志。并发下壁Q波梗死的房室传导阻滞和束支传导阻滞预后良好。左束支传导阻滞似乎是一种更慢性的病变，死亡率中等，孤立的左前分支阻滞对短期预后没有不利影响。这些结果与西方系列研究中观察到的模式非常吻合。传导缺陷的高发生率，特别是并发前间隔梗死的右束支传导阻滞和房室传导阻滞，表明中国人急性心肌梗死的临床谱更严重，这可能是导致中国患者系列研究中医院内死亡率较高的原因之一。
