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宏观T波交替：肝硬化患者的异常表现。

Macroscopic T-Wave Alternans: Unusual Presentation in a Cirrhotic Patient.

作者信息

Soodi Deepa, Cirra Vinod K Reddy, Sharma Param

机构信息

Cardiology, Marshfield Clinic Health System, Marshfield, USA.

Internal Medicine, Deccan College of Medical Sciences, Hyderabad, IND.

出版信息

Cureus. 2025 Feb 28;17(2):e79840. doi: 10.7759/cureus.79840. eCollection 2025 Feb.

DOI:10.7759/cureus.79840
PMID:40161085
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11955219/
Abstract

T-wave alternans (TWA), also known as repolarization alterations, refers to the alternating pattern observed in the ST segment, T wave, and U wave. Macroscopic TWA (MTWA) has been observed in patients with various conditions, such as ischemia, electrolyte imbalances, long QT syndrome, and transitions from tachycardia to a normal rhythm. Its recognition is of utmost importance as it serves as a red flag for potentially life-threatening cardiac arrhythmias. Prompt treatment is crucial in order to prevent cardiac arrest and its complications. Patients who exhibit MTWA should be promptly treated with intravenous magnesium sulfate, as magnesium deficiency can contribute to arrhythmias. Additionally, efforts should be made to identify and address any reversible causes that may be contributing to the MTWA. Timely intervention is key to achieving the best possible outcome for patients with MTWA.

摘要

T波交替（TWA），也称为复极化改变，是指在ST段、T波和U波中观察到的交替模式。在患有各种病症的患者中已观察到宏观T波交替（MTWA），如缺血、电解质失衡、长QT综合征以及从心动过速转变为正常心律的情况。识别MTWA至关重要，因为它是潜在危及生命的心律失常的警示信号。及时治疗对于预防心脏骤停及其并发症至关重要。表现出MTWA的患者应立即静脉注射硫酸镁进行治疗，因为镁缺乏可能导致心律失常。此外，应努力识别并解决任何可能导致MTWA的可逆性病因。及时干预是使MTWA患者获得最佳预后的关键。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5103/11955219/49866ca1eb16/cureus-0017-00000079840-i06.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5103/11955219/8ec8e785e769/cureus-0017-00000079840-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5103/11955219/f2ced872ebb1/cureus-0017-00000079840-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5103/11955219/22587091ee34/cureus-0017-00000079840-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5103/11955219/8cd8c2297853/cureus-0017-00000079840-i04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5103/11955219/990674a973ac/cureus-0017-00000079840-i05.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5103/11955219/49866ca1eb16/cureus-0017-00000079840-i06.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5103/11955219/8ec8e785e769/cureus-0017-00000079840-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5103/11955219/f2ced872ebb1/cureus-0017-00000079840-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5103/11955219/22587091ee34/cureus-0017-00000079840-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5103/11955219/8cd8c2297853/cureus-0017-00000079840-i04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5103/11955219/990674a973ac/cureus-0017-00000079840-i05.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5103/11955219/49866ca1eb16/cureus-0017-00000079840-i06.jpg

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本文引用的文献

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Cureus. 2022 Jan 19;14(1):e21421. doi: 10.7759/cureus.21421. eCollection 2022 Jan.
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Macroscopic T-wave alternans in a patient presenting with hepatic encephalopathy.肝性脑病患者出现的宏观 T 波交替。
J Electrocardiol. 2021 Mar-Apr;65:110-112. doi: 10.1016/j.jelectrocard.2021.01.011. Epub 2021 Jan 26.
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T-wave alternans: a harbinger of polymorphic ventricular tachycardia.
T波交替：多形性室性心动过速的先兆。
Oxf Med Case Reports. 2019 Sep 28;2019(9):omz095. doi: 10.1093/omcr/omz095. eCollection 2019 Sep.
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Q-T Interval Prolongation in Patients with Liver Cirrhosis.肝硬化患者的QT间期延长
Curr Health Sci J. 2018 Jul-Sep;44(3):274-279. doi: 10.12865/CHSJ.44.03.11. Epub 2018 Jul 15.
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Diagnosis and Management of Alcoholic Liver Disease.酒精性肝病的诊断与治疗。
J Clin Transl Hepatol. 2015 Jun 28;3(2):109-16. doi: 10.14218/JCTH.2015.00008. Epub 2015 Jun 15.
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Cardiac electrophysiological abnormalities in patients with cirrhosis.肝硬化患者的心脏电生理异常
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Microvolt T-wave alternans and the risk of death or sustained ventricular arrhythmias in patients with left ventricular dysfunction.左心室功能障碍患者的微伏级T波交替与死亡或持续性室性心律失常风险
J Am Coll Cardiol. 2006 Jan 17;47(2):456-63. doi: 10.1016/j.jacc.2005.11.026. Epub 2005 Dec 15.
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