Movahed A, Becker L C
J Am Coll Cardiol. 1984 Oct;4(4):660-6. doi: 10.1016/s0735-1097(84)80390-3.
To determine how often acute lateral myocardial infarcts may be electrocardiographically "silent," a new approach was utilized in which subjects were selected by admission thallium scintigraphy. Thirty-one patients with their first infarction were identified with moderate to severe perfusion defects of the lateral and posterolateral walls, persistent over 7 days and associated with severe wall motion abnormalities. Patients with involvement of the anterior, septal or "inferior" regions were not included. In nine patients, the perfusion defect extended to the anterolateral wall: all developed ST elevation and Q waves in at least one of the "lateral" leads (I, aVL or V6) but none showed changes in the "inferior" leads (II, III or aVF). In the other 22 patients, the perfusion defect was limited to the lateral and posterolateral walls: only 12 showed ST elevations (inferior leads only in 7, lateral leads only in 2, both leads in 3) and only 9 developed Q waves (inferior in all). In 8 of these 22 patients, the infarct was silent in the sense that no ST segment elevation or Q waves were seen, although ST depressions or T wave inversions, or both, in all but one patient were compatible with subendocardial infarction. The results indicate that the standard electrocardiogram is insensitive to changes in the lateral and posterolateral regions. Additional diagnostic studies are needed for proper localization and sizing of acute myocardial infarcts.
为了确定急性侧壁心肌梗死在心电图上“隐匿”的频率，采用了一种新方法，即通过入院时的铊闪烁扫描来选择研究对象。31例首次发生心肌梗死的患者被确定存在侧壁和后侧壁中度至重度灌注缺损，持续超过7天，并伴有严重的室壁运动异常。前壁、间隔或“下壁”区域受累的患者未纳入研究。9例患者的灌注缺损扩展至前侧壁：所有患者至少在一个“侧壁”导联（I、aVL或V6）出现ST段抬高和Q波，但无一例在“下壁”导联（II、III或aVF）出现改变。在另外22例患者中，灌注缺损仅限于侧壁和后侧壁：仅12例出现ST段抬高（7例仅在下壁导联，2例仅在侧壁导联，3例在两个导联均出现），仅9例出现Q波（均在下壁导联）。在这22例患者中的8例，梗死在心电图上表现为隐匿，即未见ST段抬高或Q波，尽管除1例患者外，所有患者的ST段压低或T波倒置，或两者兼有，均符合心内膜下梗死。结果表明，标准心电图对侧壁和后侧壁区域的变化不敏感。对于急性心肌梗死的正确定位和大小评估，需要进行额外的诊断性检查。
