Soria R, Tenaillon A, Labrousse J, Massart J D, Lissac J
Ann Cardiol Angeiol (Paris). 1984 Apr;33(3):153-8.
The aim of this study, based on the electrocardiographic analysis of 42 patients in status asthmaticus, is to define the basic criteria which may be used as a basis for electrocardiographic differential diagnosis. The following ECG changes were observed: the pulmonary "p" wave is common, sometimes with exaggerated amplitude in peripheral leads, however, in the precordial leads, the voltage of the "p" wave is reduced; most cases have a vertical heart with clockwise rotation and mild right axis deviation, S1 Q2 Q3 and the transitional zone displaced to the left. Ten cases also had a S1 S2 S3 appearance and three cases showed Q1 Q2 Q3, simulating myocardial infarction; there is poor progression of the R wave in the precordial leads and marked persistence of the S wave in the left precordial leads. In some cases, a QS complex dominates the right precordial leads. A variation in the amplitude of the QRS with the respiratory rhythm is often seen in V1 and V2; ventricular repolarization shows a lowered J point with an upward oblique ST segment in the peripheral leads. However, in the precordial leads, the repolarization is normal except for three cases which presented a frank hypokalaemia. The mechanism of these electrocardiographic changes appears to depend on the vertical position of the heart caused by over expansion of the lungs and pulmonary arterial hypertension. The elements of the electrocardiographic differential diagnosis with myocardial infarction and pulmonary embolism are discussed.
本研究旨在通过对42例哮喘持续状态患者的心电图分析，确定可作为心电图鉴别诊断依据的基本标准。观察到以下心电图变化：肺性“P”波常见，有时在外周导联中振幅增大，但在心前导联中，“P”波电压降低；大多数病例心脏呈垂直位，顺钟向转位，有轻度电轴右偏，S1Q2Q3，过渡区向左移位。10例患者还出现S1S2S3图形，3例显示Q1Q2Q3，类似心肌梗死；心前导联R波进展不良，左心前导联S波明显持续存在。在某些情况下，QS波群在右心前导联占主导。V1和V2导联常可见QRS波振幅随呼吸节律变化；心室复极在外周导联表现为J点降低，ST段呈上斜型。然而，在心前导联中，除3例出现明显低钾血症外，复极正常。这些心电图变化的机制似乎取决于肺部过度扩张和肺动脉高压导致的心脏垂直位置。文中讨论了与心肌梗死和肺栓塞进行心电图鉴别诊断的要点。
