Sinha N, Ahuja R C, Saran R K, Jain G C
Department of Cardiology, Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Lucknow, India.
Int J Cardiol. 1989 Jul;24(1):55-61. doi: 10.1016/0167-5273(89)90041-7.
Right ventricular infarction was diagnosed on the basis of ST-segment elevation greater than or equal to 1 mm in at least one right precordial lead (V3R-V6R) in 20 of 50 patients with first acute inferior myocardial infarction. Seventy five percent of these had ST elevation in 2 or more right precordial leads. Giddiness and hiccups were more common amongst such patients (P less than 0.05). Signs of right ventricular dysfunction-raised jugular venous pressure (65%), Kussmaull's sign (45%), hypotension (without cardiogenic shock, 40%) and right-sided third sound (25%) in the absence of clinical left ventricular failure, were noted in 65% of such patients. Eleven patients had 2 or more of the above signs. ST elevation in 2 or more right precordial leads was found in 10 of these 11 patients. A more complicated course in the hospital characterised by bradyarrhythmias, hypotension and cardiogenic shock, combined with a greater mortality was seen in such patients. We conclude that the bedside diagnosis of haemodynamically significant right ventricular infarction can be made on the basis of a combination of clinical signs and ST elevation in 2 or more right precordial leads, even in units not equipped for bedside haemodynamic monitoring, echocardiography and radionuclide studies. This should lead to a better identification and management of such patients.
在50例首次发生急性下壁心肌梗死的患者中，有20例根据至少一个右胸前导联（V3R-V6R）ST段抬高≥1mm诊断为右心室梗死。其中75%的患者在两个或更多右胸前导联出现ST段抬高。此类患者中头晕和呃逆更为常见（P<0.05）。在65%的此类患者中，在无临床左心室衰竭的情况下，注意到右心室功能障碍的体征——颈静脉压升高（65%）、库斯莫尔征（45%）、低血压（无心源性休克，40%）和右侧第三心音（25%）。11例患者有上述两种或更多体征。这11例患者中有10例在两个或更多右胸前导联出现ST段抬高。此类患者在医院的病程更复杂，以缓慢性心律失常、低血压和心源性休克为特征，且死亡率更高。我们得出结论，即使在没有床边血流动力学监测、超声心动图和放射性核素检查设备的单位，基于临床体征和两个或更多右胸前导联ST段抬高的组合，也可对血流动力学显著的右心室梗死进行床边诊断。这应能更好地识别和管理此类患者。
