Merx W, Meyer J, von Essen R, Erbel R, Schweizer P, Püllen C, Rupprecht J, Effert S
Dtsch Med Wochenschr. 1982 Apr 16;107(15):565-70. doi: 10.1055/s-2008-1069977.
The right ventricular filling pressure was raised above 10 mm Hg in 20 cases (12%) out of 175 patients haemodynamically monitored in the acute phase after cardiac infarction. The end-diastolic pulmonary arterial pressure was not above 18 mm Hg so that in these cases an extensive necrosis of the right ventricle must be assumed to be the cause of right heart failure. In 75% of these patients with predominantly right sided infarction there was a posterior wall infarct whereas in patients with left heart failure the anterior wall was significantly more often affected. Patients with posterior wall infarction and right heart failure had more commonly infarct signs in the right precordial chest leads Vr3 to Vr6 and an increased diameter of the right ventricle in the echocardiogram than patients with posterior wall infarction but without right heart failure. However, a definite separation of the two groups was not possible with these non-invasive techniques. Haemodynamic changes should thus be decisive for the diagnosis of predominantly right heart infarction as these dictate the treatment.
在心肌梗死急性期接受血流动力学监测的175例患者中，有20例（12%）右心室充盈压升高至10 mmHg以上。舒张末期肺动脉压不高于18 mmHg，因此在这些病例中，必须假定右心室广泛坏死是右心衰竭的原因。在这些以右心梗死为主的患者中，75%存在后壁梗死，而在左心衰竭患者中，前壁受累的频率明显更高。与后壁梗死但无右心衰竭的患者相比，后壁梗死合并右心衰竭的患者在右胸前导联Vr3至Vr6更常出现梗死征象，超声心动图显示右心室直径增大。然而，通过这些非侵入性技术无法明确区分这两组患者。因此，血流动力学变化对于以右心梗死为主的诊断应起决定性作用，因为这些变化决定了治疗方案。
