Ivanov Igor, Bugarski Sonja, Dejanović Jadranka, Stojsić Milosavljević Anastazija, Radisić Bosić Jasna, Vujin Bojan
Institute for Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia.
Med Pregl. 2013 Nov-Dec;66(11-12):503-6. doi: 10.2298/mpns1312503i.
Acute myocardial infarction is characterized by typical chest pain, electrocardiographic changes in terms of lesion and/or myocardial ischemia and increased cardiac enzymes. It is often difficult to make diagnosis in the presence of non-specific chest pain, the short duration of symptoms and electrocardiographic signs of a complete left bundle branch block.
Many authors have tried to set the electrocardiographic criteria that can increase the possibility of correct diagnosis of acute myocardial infarction in such situations. The most widely used and recognized criterion is Sgarbossa scoring system that includes concordant ST segment elevation > 1 mm ST segment, disconcordant denivelation of ST segment > 1 mm in the leads V1-V3 and disconcordant ST segment elevation > 5 mm with acceptable sensitivity and specificity. In subsequent studies, the sensitivity and specificity increased by replacing the third criterion with ST/S ratio < -0.25.
The knowledge of certain electrocardiographic signs in patients with acute coronary syndrome and left bundle branch block increases the chances of early diagnosis and the possibility of better and timely treatment.
急性心肌梗死的特征为典型胸痛、病变和/或心肌缺血方面的心电图改变以及心肌酶升高。在存在非特异性胸痛、症状持续时间短以及完全性左束支传导阻滞的心电图表现时，往往难以做出诊断。
许多作者试图设定心电图标准，以增加在此类情况下正确诊断急性心肌梗死的可能性。使用最广泛且被认可的标准是Sgarbossa评分系统，该系统包括ST段抬高>1mm的同向性ST段、V1-V3导联中ST段压低>1mm的异向性偏移以及ST段抬高>5mm的异向性ST段，具有可接受的敏感性和特异性。在随后的研究中，通过用ST/S比值<-0.25替代第三个标准，敏感性和特异性有所提高。
了解急性冠状动脉综合征和左束支传导阻滞患者的某些心电图表现可增加早期诊断的机会以及更好、及时治疗的可能性。
