Saito D, Ueeda M, Yamada N, Hina K, Watanabe H, Mima T, Yoshida H, Haraoka S, Tsuji T
First Department of Internal Medicine, Okayama University Medical School, Japan.
Jpn Circ J. 1988 Nov;52(11):1268-76. doi: 10.1253/jcj.52.1268.
Interventricular septal involvement in myocardial infarction is suggested by the findings of a QS deflection in lead V1 and/or absence of the Q wave in leads I and V6, using the standard 12-lead electrocardiogram (ECG). However, these findings were not sufficiently established for the criteria of septal infarction, because several factors including anatomic position of the heart, changes of intraventricular conduction, and condition of the lung would affect the QRS complex in the leads. In this study, we analyzed the ECGs of anterior myocardial infarction with (group A) and without (group B) involvement of the first septal coronary artery. The R wave in V1 was absent in 64.7% of group A and 60.0% of group B. The Q wave was absent in 35.3% in lead I and 64.7% in lead V6 of group A, while in group B the Q wave in leads I and V6 were not observed in 60.0% and 40.0%, respectively. The prevalence rates of the R wave and the Q wave in these leads were not significantly different between the two groups. Left ventriculography revealed that the prevalence rate of the R wave in V1, and the Q wave in I and V6 was not significantly different, regardless of the presence or absence of impaired septal motion. Experimental study in anesthetized dogs confirmed the difficulty in clarifying acute septal ischemia by changes in the QRS complex. These results indicate that septal myocardial infarction is hardly detectable with changes in the QRS complex of the standard 12-lead electrocardiogram.
使用标准12导联心电图（ECG）时，V1导联出现QS波和/或I导联及V6导联Q波缺失的表现提示心肌梗死累及室间隔。然而，这些表现作为室间隔梗死的标准并不充分，因为包括心脏解剖位置、室内传导变化及肺部情况等多种因素会影响导联中的QRS波群。在本研究中，我们分析了累及（A组）和未累及（B组）第一间隔冠状动脉的前壁心肌梗死患者的心电图。A组64.7%、B组60.0%的患者V1导联R波缺失。A组I导联35.3%、V6导联64.7%的患者Q波缺失，而B组I导联和V6导联Q波未出现的比例分别为60.0%和40.0%。两组这些导联中R波和Q波的发生率无显著差异。左心室造影显示，无论室间隔运动是否受损，V1导联R波以及I导联和V6导联Q波的发生率无显著差异。对麻醉犬的实验研究证实，通过QRS波群变化难以明确急性室间隔缺血。这些结果表明，标准12导联心电图的QRS波群变化很难检测出室间隔心肌梗死。
