Sewdarsen M, Vythilingum S, Moodley T
Coronary Care Unit, R.K. Khan Hospital, Durban.
S Afr Med J. 1988 Jan 9;73(1):9-11.
The incidence, diagnosis and clinical course of haemodynamically significant right ventricular infarction (RVI) were assessed prospectively in 90 patients with their first acute inferior myocardial infarction. The haemodynamic criteria for RVI were defined as a mean right atrial pressure of 10 mmHg or more and a mean right atrial pressure equal to or greater than the mean pulmonary capillary wedge pressure. Twenty-six patients (29%) had haemodynamic evidence of RVI (group A) whereas 64 (71%) did not meet the criteria (group B). ST-segment elevation in lead V4R was observed in 25 patients (96%) with haemodynamic evidence of RVI and in 15 (23%) without (P less than 0.001). The jugular venous pressure (JVP) was found to be elevated in 24 of the 26 group A and in 7 of the 64 group B patients (P less than 0.001). Kussmaul's sign was present in 21 group A and 3 group B patients (P less than 0.001). Of the clinical signs, elevation of the JVP with clear lung fields on the chest radiograph had the best predictive value (92%) for haemodynamically significant RVI. The ECG was highly sensitive (96%) but less specific (77%) and had a low predictive value (63%) for haemodynamically significant RVI. Hypotension and complete atrioventricular block occurred more frequently in group A patients (P less than 0.001 and P less than 0.01 respectively). The hospital mortality rate was similar in both groups.
对90例首次发生急性下壁心肌梗死的患者进行前瞻性评估，以确定血流动力学显著的右心室梗死（RVI）的发生率、诊断及临床病程。RVI的血流动力学标准定义为平均右心房压≥10 mmHg，且平均右心房压等于或高于平均肺毛细血管楔压。26例患者（29%）有RVI的血流动力学证据（A组），而64例（71%）不符合标准（B组）。有RVI血流动力学证据的25例患者（96%）及无该证据的15例患者（23%）出现V4R导联ST段抬高（P<0.001）。发现A组26例中的24例及B组64例中的7例颈静脉压（JVP）升高（P<0.001）。A组21例及B组3例出现库斯莫尔征（P<0.001）。在临床体征中，胸部X线片显示肺野清晰时JVP升高对血流动力学显著的RVI具有最佳预测价值（92%）。心电图对血流动力学显著的RVI高度敏感（96%）但特异性较低（77%），预测价值较低（63%）。A组患者低血压和完全性房室传导阻滞更常见（分别为P<0.001和P<0.01）。两组的医院死亡率相似。
