DIAGNOSTIC ELECTROCARDIOGRAPHIC SEQUENCES IN ACUTE PERICARDITIS - SIGNIFICANCE OF PR SEGMENT AND PR VECTOR CHANGES
DIAGNOSTIC ELECTROCARDIOGRAPHIC SEQUENCES IN ACUTE PERICARDITIS - SIGNIFICANCE OF PR SEGMENT AND PR VECTOR CHANGES
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DOI：
10.1161/01.cir.48.3.575
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发表时间：
1973-01-01
期刊：
影响因子：
37.8
通讯作者：
SPODICK, DH
中科院分区：
文献类型：
--
作者：
SPODICK, DH
对 50 名具有明确急性心包炎临床证据的连续患者的诊断心电图模式进行了分析。 P 和 QRS 以及 P-R 段、ST 段和 T 波变化的分布按导联和平均额叶向量 ( ) 绘制。 41 名患者 (82%) 出现 P-R 段短暂性总体偏差，主要发生在第 1 和/或第 2 阶段，当 J 点实际上位于基线时，可能会产生 ST 抬高的错觉。 P-R与P相反接近180°，与P波或心率变化无关。在第 1 阶段，ST 倾向于与 QRS 和 T 一致。第 3 阶段的 T 波倒置产生 T，分布在 210° 的弧上，没有偏爱范围。正常定向 PR 向量幅度的瞬时增加与急性心包炎的心外膜下心房损伤一致。它与心外膜下心室损伤的经典 1 期 ST 段异常类似，在心电图中同样广泛存在，几乎同样普遍。 P-R 段偏差始终是“心外膜”模式导联的凹陷。 10 名患者的 ST 段偏差偏离了经典的抬高模式：7 名患者在 III 导联中 ST 压低，其中 5 名患者具有水平 QRS 轴； 3 例 aVL 区 ST 压低，其中 2 例 QRS 轴垂直。在第 3 阶段，与相对集中的早期损伤向量 P-R 和 ST 相比，T 的范围要宽得多，这归因于损伤后心室复极的不均匀性更大。
Diagnostic electrocardiographic patterns were analyzed in 50 consecutive patients who had unequivocal clinical evidence of acute pericarditis. Distributions of P and QRS, and of P-R segment, ST-segment and T wave changes were plotted by lead and by mean frontal vector (Â). Transient gross deviations of P-R segments, mainly in Stages 1 and/or 2, occurred in 41 patients (82%) and could produce an optical illusion of ST elevations when the J-points were actually on the baseline.  P-R was close to 180° opposite to  P and was not related to P wave or heart rate changes. In Stage 1,  ST tended to be concordant with  QRS and  T. T wave inversions in Stage 3 produced an  T which was distributed over an arc of 210° with no range of predilection.Transient increase in magnitude of a normally oriented PR vector was consistent with the subepicardial atrial injury of acute pericarditis. It is the analogue of the classic Stage 1 ST-segment abnormalities of subepicardial ventricular injury and was equally as widespread in the electorcardiogram and almost as prevalent. P-R segment deviations were always depressions for leads of "epicardial" patterns. ST-segment deviations departed from the classic elevation pattern in 10 patients: 7 patients in whom ST was depressed in Lead III, 5 of whom had a horizontal QRS axis; and 3 patients in whom ST was depressed in aVL, two of whom had a vertical QRS axis. In Stage 3, the much wider range for  T as compared with the relatively concentrated early injury vectors,  P-R and  ST, is ascribed to greater inhomogeneity of post-injury ventricular repolarization.