The electrocardiographic diagnosis of acute myocardial infarction in patients with ventricular paced rhythms.
The electrocardiographic diagnosis of acute myocardial infarction in patients with ventricular paced rhythms.
复制标题
室性起搏节律患者急性心肌梗死的心电图诊断。
DOI：
10.1111/j.1553-2712.1998.tb02575.x
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发表时间：
1998
期刊：
影响因子：
--
通讯作者：
R. S. Buckley
中科院分区：
文献类型：
--
作者：
Frederick H. Kozlowski;W. Brady;T. Aufderheide;R. S. Buckley
在心室起搏节律 (VPR) 的情况下，使用心电图诊断缺血性心脏病更加困难。 ST 段/T 波结构因心室起搏相关的心室内传导改变而改变。 VPR 患者的预期形态是 QRS 复合波 ST 段与 T 波不一致之一。医生可以采用多种策略来帮助正确解释带有永久心室起搏器的患者的 12 导联心电图，包括： 了解 VPR 的预期 ST 段 T 波变化，从而识别急性缺血形态的能力；连续心电图或 ST 段趋势监测的表现，显示急性缺血患者遇到的动态变化；与之前的心电图比较；如果合适的话，还可以对原生的、潜在的节奏进行分析。第一个策略是了解 VPR 的预期 ST 段形态，这是最重要的，并且不依赖于额外的诊断测试、过去的医疗记录或起搏器功能方面的额外专业知识。据报道，在 VPR 情况下对心电图进行分析的两例病例有助于治疗医生对急性心肌梗死做出正确的诊断。
Use of the ECG for diagnosis of ischemic heart disease is more difficult in the setting of ventricular paced rhythms (VPRs). ST-segment/T-wave configuration are changed by the altered intraventricular conduction associated with ventricular pacing. The anticipated, or expected, morphology in patients with VPRs is one of QRS-complex-ST-segment to T-wave discordance. Several strategies are available to the physician to assist in the correct interpretation of the 12-lead ECG in patients with permanent ventricular pacemakers, including: a knowledge of the anticipated ST-segment-T-wave changes of VPRs and consequently the ability to recognize acute, ischemic morphologies; the performance of serial ECGs or ST-segment trend monitoring demonstrating dynamic changes encountered in acutely ischemic patients; a comparison with previous ECGs; and, if appropriate, an analysis of the native, underlying rhythm. The first strategy, an awareness of the anticipated ST-segment morphologies of VPRs, is the most important and not dependent on additional diagnostic testing, past medical records, or additional expertise in pacemaker function. Two cases are reported in which an analysis of the ECG in the setting of VPR assisted the treating physicians in establishing the correct diagnosis of acute myocardial infarction.