Kriwisky M, Ackerman Z, Mosseri M, Gotsman M S, Hasin Y
Clin Cardiol. 1987 Jan;10(1):57-61. doi: 10.1002/clc.4960100113.
Right ventricular infarction occurs in 19-43% of patients with acute inferior wall infarction (Lorell et al., 1979). Its clinical, hemodynamic, and anatomic features are well known and include associated inferior wall infarction, distended neck veins, clear lung fields, hypotension, and heart block (Cintron et al., 1981; Coma-Canella et al., 1979; Lloyd et al., 1981; Lopez-Sendon et al., 1981; Raabe and Chester, 1978; Rotman et al., 1974). Isolated right ventricular infarction is less frequent and occurs in 2.5-4.6% of autopsy studies of myocardial infarction (Cohn et al., 1974; Erhardt et al., 1976; Wartman and Hellerstein, 1948). This report describes a patient with isolated right ventricular infarction with unusual electrophysiological findings. Her initial electrocardiogram showed atrial escape rhythm with incomplete right bundle-branch block and left posterior hemiblock. Later, she developed atrioventricular (AV) block with supra- and infra-Hisian, "phase 4," conduction defects. The sinus malfunction and high degree AV block persisted over 2 weeks and an atrioventricular sequential pacemaker was implanted. Hymodynamic study showed that her cardiac output was highly dependent on the heart rate and properly timed AV interval, and the pacemaker was programmed accordingly.
右心室梗死发生于19% - 43%的急性下壁梗死患者中（洛雷尔等人，1979年）。其临床、血流动力学及解剖学特征已为人熟知，包括合并下壁梗死、颈静脉怒张、肺野清晰、低血压及心脏传导阻滞（辛特龙等人，1981年；科马 - 卡内拉等人，1979年；劳埃德等人，1981年；洛佩斯 - 森登等人，1981年；拉贝和切斯特，1978年；罗特曼等人，1974年）。孤立性右心室梗死较少见，在心肌梗死尸检研究中发生率为2.5% - 4.6%（科恩等人，1974年；埃尔哈特等人，1976年；沃特曼和赫勒斯坦，1948年）。本报告描述了一名具有不寻常电生理表现的孤立性右心室梗死患者。她最初的心电图显示房性逸搏心律伴不完全性右束支传导阻滞及左后分支阻滞。后来，她出现了房室（AV）阻滞，合并希氏束上和希氏束下“4相”传导缺陷。窦性功能障碍和高度房室阻滞持续了2周以上，随后植入了房室顺序起搏器。血流动力学研究表明，她的心输出量高度依赖于心率及适时的房室间期，起搏器也据此进行了程控。
