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A counterpoint paper: Comments on the electrocardiographic part of the 2018 Fourth Universal Definition of Myocardial Infarction endorsed by the International Society of Electrocardiology and the International Society for Holter and Noninvasive Electrocardiology.一篇反驳文章：对国际心电图学会和国际动态心电图与无创心电图学会认可的 2018 年心肌梗死第四通用定义心电图部分的评论。
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本文引用的文献

1
Fourth Universal Definition of Myocardial Infarction (2018).心肌梗死的第四次全球定义（2018年）。
Glob Heart. 2018 Dec;13(4):305-338. doi: 10.1016/j.gheart.2018.08.004. Epub 2018 Aug 25.
2
Cardiac Magnetic Resonance Evaluation of the Extent of Myocardial Injury in Patients with Inferior ST Elevation Myocardial Infarction and Concomitant ST Depression in Leads V1-V3: Analysis from the MITOCARE Study.下壁ST段抬高型心肌梗死合并V1-V3导联ST段压低患者心肌损伤范围的心脏磁共振评估：来自MITOCARE研究的分析
Cardiology. 2018;140(3):178-185. doi: 10.1159/000491745. Epub 2018 Aug 10.
3
Diffuse ST-Segment Depression with ST-Segment Elevation in Lead aVR in 12-Lead Electrocardiography May Indicate Ischemic Change of Severe Aortic Stenosis.12导联心电图中aVR导联ST段抬高伴弥漫性ST段压低可能提示严重主动脉瓣狭窄的缺血性改变。
Acta Cardiol Sin. 2015 Sep;31(5):449-52. doi: 10.6515/acs20140813a.
4
Precordial junctional ST-segment depression with tall symmetric T-waves signifying proximal LAD occlusion, case reports of STEMI equivalence.前壁交界性ST段压低伴高耸对称T波提示左前降支近端闭塞，等同于ST段抬高型心肌梗死的病例报告
J Electrocardiol. 2016 Jan-Feb;49(1):76-80. doi: 10.1016/j.jelectrocard.2015.10.005. Epub 2015 Oct 13.
5
ECG diagnosis and classification of acute coronary syndromes.急性冠状动脉综合征的心电图诊断与分类
Ann Noninvasive Electrocardiol. 2014 Jan;19(1):4-14. doi: 10.1111/anec.12130. Epub 2013 Dec 30.
6
Diffuse ST depression with ST elevation in aVR: Is this pattern specific for global ischemia due to left main coronary artery disease?弥漫性ST段压低伴aVR导联ST段抬高：这种心电图表现是否为左主干冠状动脉疾病所致广泛性心肌缺血的特异性表现？
J Electrocardiol. 2013 May-Jun;46(3):240-8. doi: 10.1016/j.jelectrocard.2012.12.016. Epub 2013 Jan 9.
7
Clinical features, management, and prognosis of spontaneous coronary artery dissection.自发性冠状动脉夹层的临床特征、处理和预后。
Circulation. 2012 Jul 31;126(5):579-88. doi: 10.1161/CIRCULATIONAHA.112.105718. Epub 2012 Jul 16.
8
Introducing a new algorithm in inferior ST-segment elevation myocardial infarction to predict the culprit artery and distinguish proximal versus distal lesions.介绍一种用于下壁ST段抬高型心肌梗死的新算法，以预测罪犯血管并区分近端与远端病变。
Coron Artery Dis. 2011 May;22(3):165-70. doi: 10.1097/MCA.0b013e328342c748.
9
AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part VI: acute ischemia/infarction: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society. Endorsed by the International Society for Computerized Electrocardiology.美国心脏协会/美国心脏病学会基金会/心律学会心电图标准化与解读建议：第六部分：急性缺血/梗死：美国心脏协会心电图与心律失常委员会、临床心脏病学理事会、美国心脏病学会基金会及心律学会的科学声明。经国际计算机化心电图学会认可。
J Am Coll Cardiol. 2009 Mar 17;53(11):1003-11. doi: 10.1016/j.jacc.2008.12.016.
10
The value of upsloping ST depression in diagnosing myocardial ischemia.上斜型ST段压低在诊断心肌缺血中的价值。
Ann Noninvasive Electrocardiol. 2006 Jul;11(3):237-40. doi: 10.1111/j.1542-474X.2006.00109.x.

ST段压低上斜型：是急性缺血吗？

Upsloping ST depression: Is it acute ischemia?

作者信息

Alam Mahboob, Nikus Kjell, Fiol Miguel, Bayes de Luna Antoni, Birnbaum Yochai

机构信息

The Section of Cardiology, Baylor College of Medicine and Texas Heart Institute, Baylor St Luke Medical Center, Houston, Texas.

The Heart Center, Faculty of Medicine and Life Sciences, Tampere University Hospital, University of Tampere, Tampere, Finland.

出版信息

Ann Noninvasive Electrocardiol. 2019 May;24(3):e12607. doi: 10.1111/anec.12607. Epub 2018 Nov 2.

DOI:10.1111/anec.12607
PMID:30387541
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6931685/
Abstract

We describe a patient with acute coronary syndrome, presenting with upsloping ST depression in leads I, II, V3-V6 and ST elevation in lead aVR. Coronary angiography revealed spontaneous dissection in a big, dominant left circumflex artery. No other lesions identified. During stenting of the dissection site, the distal left circumflex, supplying a large posterior descending artery was occluded, resulting in ST elevation myocardial infarction with ST elevation in lead III and aVF, but not II. This pattern is considered to represent right coronary artery infarction, rather than left circumflex infarction.

摘要

我们描述了一名患有急性冠状动脉综合征的患者，其心电图表现为 I、II、V3-V6 导联 ST 段压低呈上升型，aVR 导联 ST 段抬高。冠状动脉造影显示一支粗大的优势左旋支动脉自发夹层形成，未发现其他病变。在对夹层部位进行支架置入时，供应粗大后降支动脉的左旋支远端闭塞，导致 ST 段抬高型心肌梗死，表现为 III 导联和 aVF 导联 ST 段抬高，但 II 导联未出现 ST 段抬高。这种心电图表现被认为代表右冠状动脉梗死，而非左旋支梗死。