Carson W, Tseng Y Z
Department of Medicine, National Taiwan University Hospital, Taipei, ROC.
Int J Cardiol. 1994 Feb;43(2):165-73. doi: 10.1016/0167-5273(94)90005-1.
Seventy patients with acute myocardial infarction were studied by serial vectorcardiography. Eleven out of 70 patients had acute myocardial infarction, which consistently met the vectorcardiographic QRS-loop criteria of anteroseptal myocardial infarction within the 21 days follow-up period. From the first vectorcardiographic tracings three types of the maximal spatial ST-vector were seen. Their directions belonged to one of the following octants: (1) right-anterior-superior, (2) left-anterior-superior, or (3) left-anterior-inferior. The directions were the same as the types of initial activity of the normal depolarization process of the interventricular septum revealed by the intracardiac mapping in dogs. The subsequent vectorcardiograms showed no change in direction of the maximal spatial ST-vector in all patients except one. This study suggested that there are three types of the maximal spatial ST-vector concealed in patients with first acute anteroseptal myocardial infarction. Each type of the maximal spatial ST-vectors is capable of causing S-T segment elevation from leads V1 to V3 in the acute electrocardiogram. Why the subgroup of the right-anterior-superior maximal spatial ST-vector in patients with acute anteroseptal myocardial infarction had poor outcomes during the acute stage needs further investigation.
对70例急性心肌梗死患者进行了系列心电向量图研究。70例患者中有11例发生急性心肌梗死，在21天的随访期内均符合前间壁心肌梗死的心电向量图QRS环标准。从最初的心电向量图记录中可以看到三种类型的最大空间ST向量。它们的方向属于以下八个卦限之一：（1）右前上，（2）左前上，或（3）左前下。这些方向与通过犬心内标测揭示的室间隔正常去极化过程的初始活动类型相同。除1例患者外，所有患者随后的心电向量图显示最大空间ST向量方向无变化。本研究提示，首次急性前间壁心肌梗死患者中隐藏着三种类型的最大空间ST向量。每种类型的最大空间ST向量在急性心电图中都能够引起V1至V3导联的ST段抬高。急性前间壁心肌梗死患者中右前上最大空间ST向量亚组在急性期预后较差的原因需要进一步研究。
