Mehta A B, Mardikar H M
Department of Cardiology, LTMG Hospital, Bombay.
J Assoc Physicians India. 1995 Sep;43(9):619-20.
In patients with recent myocardial infarction (MI), exercise induced ST segment elevation on infarct related leads is shown to be due to ischaemia within or around partially necrotic area. To study this hypothesis we studied 15 patients of recent MI who had ST segment elevation in infarct related leads. In 13 patients infarct related artery was patient with severe stenosis (85 +/- 8%) and in 2 patients infarct related artery was totally occluded. The patients with patent culprit artery were elected for percutaneous transluminal coronary angioplasty (PTCA). During balloon inflation 10 patients had ST segment elevation on some leads that showed ST elevation during exercise and 6 patients also had angina. There was no significant change in pulmonary artery pressure and systemic blood pressure during PTCA. Post PTCA stress test after 2 week showed decrease in ST elevation compared to previous stress tests. Therefore exercise induced ST segment elevation in infarct related leads is suggestive of ischaemia rather that left ventricular dysfunction. In such patients it may be considered as indication for revascularization.
在近期发生心肌梗死（MI）的患者中，梗死相关导联上运动诱发的ST段抬高被证明是由于部分坏死区域内或其周围的缺血所致。为了研究这一假说，我们对15例近期发生MI且梗死相关导联出现ST段抬高的患者进行了研究。13例患者的梗死相关动脉存在严重狭窄（85±8%），2例患者的梗死相关动脉完全闭塞。对梗死相关动脉通畅的患者选择进行经皮腔内冠状动脉成形术（PTCA）。在球囊扩张过程中，10例患者在运动时出现ST段抬高的某些导联上也出现了ST段抬高，6例患者还出现了心绞痛。PTCA过程中肺动脉压和体循环血压无显著变化。PTCA术后2周的负荷试验显示，与之前的负荷试验相比，ST段抬高有所降低。因此，梗死相关导联上运动诱发的ST段抬高提示缺血而非左心室功能障碍。在此类患者中，可将其视为血运重建的指征。
