Erhardt L R, Sjögren A
Acta Med Scand. 1978;204(4):331-3. doi: 10.1111/j.0954-6820.1978.tb08448.x.
ST segment elevations in leads CR4R or V4R indicating right ventricular (RV) involvement are sometimes seen in patients with acute inferior transmural infarction. Whether the RV lesion per se or the concomitant infarction of the posterior septum causes this ECG pattern is unknown. We describe a patient with anteroseptal transmural infarction who developed unusually marked ST segment elevations in lead V4R. At autopsy, extensive old fibrotic infarction was found, involving the anterior and lateral RV walls, as well as recent necrosis of the interventricular septum. These findings suggest that the ST segment elevation in V4R in patients with RV infarction may not be caused by the RV necrosis per se but rather by visualization of the posterior septum through the necrotic RV myocardium.
急性下壁透壁性心肌梗死患者有时可见CR4R或V4R导联ST段抬高，提示右心室（RV）受累。目前尚不清楚是右心室病变本身还是伴有后间隔梗死导致了这种心电图表现。我们描述了一名前间隔透壁性心肌梗死患者，其V4R导联出现了异常明显的ST段抬高。尸检发现广泛的陈旧性纤维化梗死，累及右心室前壁和侧壁，以及室间隔近期坏死。这些发现表明，右心室梗死患者V4R导联ST段抬高可能并非由右心室坏死本身引起，而是通过坏死的右心室心肌看到了后间隔。
