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急性心肌梗死病例中的联合ST段抬高：如何识别梗死相关动脉？

Combined ST Elevation in a Case of Acute Myocardial Infarction: How to Identify the Infarct-related Artery?

作者信息

Balasubramanian Kavitha, Ramachandran Balasubramanian, Subramanian Anandaraja, Balamurugesan Kandan

机构信息

Department of General Medicine, Indira Gandhi Medical College & Research Institute, Puducherry, India.

Department of Cardiology, Indira Gandhi Government General Hospital & Postgraduate Institute, Puducherry, India.

出版信息

Int J Appl Basic Med Res. 2018 Jul-Sep;8(3):184-186. doi: 10.4103/ijabmr.IJABMR_365_16.

DOI:10.4103/ijabmr.IJABMR_365_16
PMID:30123751
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6081999/
Abstract

Combined ST elevation in anterior and inferior ECG leads in acute myocardial infarction is not a rarity. It is both interesting and challenging to indentify the infarct related culprit artery. We report the case of a middle aged male with acute myocardial infarction whose admission ECG shows ST elevation in lead II, III, aVF as well as from V-V. 90% of such cases are due to single vessel occlusion - majority due to proximal RCA occlusion and the remaining due to mid to distal LAD occlusion. ECG features to differentiate between these two vascular occlusions are discussed. In this case at hand, lead III ST elevation of 2.5 mm and V/V≥ 1 indicates proximal RCA as the IRA and the same has been confirmed by pre-discharge coronary angiogram .

摘要

急性心肌梗死时心电图前壁和下壁导联联合ST段抬高并不罕见。识别梗死相关罪犯血管既有趣又具有挑战性。我们报告一例中年男性急性心肌梗死患者，其入院心电图显示Ⅱ、Ⅲ、aVF导联以及V1-V6导联ST段抬高。此类病例中90%是由于单支血管闭塞——大多数是由于右冠状动脉近端闭塞，其余是由于左前降支中段至远端闭塞。本文讨论了区分这两种血管闭塞的心电图特征。在本例中，Ⅲ导联ST段抬高2.5mm且V1-V6≥1提示右冠状动脉近端为梗死相关动脉，这一点已通过出院前冠状动脉造影得到证实。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f64c/6081999/29e9ef0ca2ea/IJABMR-8-184-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f64c/6081999/18208325ef3c/IJABMR-8-184-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f64c/6081999/78ef612e4784/IJABMR-8-184-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f64c/6081999/dd5693713038/IJABMR-8-184-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f64c/6081999/b96dee57c99b/IJABMR-8-184-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f64c/6081999/29e9ef0ca2ea/IJABMR-8-184-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f64c/6081999/18208325ef3c/IJABMR-8-184-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f64c/6081999/78ef612e4784/IJABMR-8-184-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f64c/6081999/dd5693713038/IJABMR-8-184-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f64c/6081999/b96dee57c99b/IJABMR-8-184-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f64c/6081999/29e9ef0ca2ea/IJABMR-8-184-g005.jpg

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本文引用的文献

1
Combined anterior and inferior ST-segment elevation Electrocardiographic differentiation between right coronary artery occlusion with predominant right ventricular infarction and distal left anterior descending branch occlusion.合并前壁和下壁ST段抬高：右冠状动脉闭塞伴主要右心室梗死与左前降支远端闭塞的心电图鉴别
J Electrocardiol. 2011 May-Jun;44(3):383-8. doi: 10.1016/j.jelectrocard.2011.02.002.
2
Electrocardiographic identification of the culprit coronary artery in inferior wall ST elevation myocardial infarction.心电图在下壁 ST 段抬高型心肌梗死罪犯血管的识别。
Can J Cardiol. 2010 Jun-Jul;26(6):293-6. doi: 10.1016/s0828-282x(10)70392-5.
3
Angiographic and clinical implications of combined ST-segment elevation in anterior and inferior leads in acute myocardial infarction.
急性心肌梗死时前壁和下壁导联ST段联合抬高的血管造影及临床意义
Clin Cardiol. 2009 Jan;32(1):21-7. doi: 10.1002/clc.20303.
4
Combined anterior and inferior ST segment elevation during the exercise stress testing.运动负荷试验期间前壁和下壁ST段联合抬高。
Int J Cardiol. 2008 Nov 28;130(3):490-3. doi: 10.1016/j.ijcard.2007.05.098. Epub 2007 Aug 24.
5
Clinical and angiographic characteristics of patients with combined anterior and inferior ST-segment elevation on the initial electrocardiogram during acute myocardial infarction.急性心肌梗死期间初始心电图表现为前壁和下壁ST段联合抬高患者的临床及血管造影特征
Am Heart J. 2003 Oct;146(4):653-61. doi: 10.1016/S0002-8703(03)00369-7.