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病例分享:除了下壁心梗,您还能看出什么异常?

2018-03-14 江苏省人民医院 卢妙 许迪 黄元铸 中国医学论坛报今日循环

1例57岁男性,因“胸部压榨痛伴大汗1小时”就诊。

1例57岁男性,因“胸部压榨痛伴大汗1小时”就诊。



图1 就诊心电图



图2 行右胸导联心电图检查(胸导联标注到V1~V6为镜像,即:V2,V1,V3R~V6R)

心电图诊断

1.窦性心律;2.心率62次/分;3.Ⅰ度房室传导阻滞;4.急性下壁心肌梗死;5.右心室心肌梗死可能。

评述

1.患者ST段抬高出现在下壁导联和侧壁导联上,Ⅰ、aVL和V1~V3导联ST段压低。当Ⅲ导联ST段抬高的幅度超过Ⅱ导联时,高度怀疑右室心肌梗死,右胸导联心电图(图2)可以明确诊断

2.急性右室心肌梗死的诊断以任何右胸导联(V3R、V4R或V5R)ST段抬高为依据。

3.急性下壁心肌梗死的患者中,约有三分之一合并急性右室心肌梗死,并与死亡率升高相关。关注急性右室心肌梗死的诊断很重要,因为右室心梗时应谨慎使用硝酸酯类及其他降低前负荷的药物。否则,可能会发生严重的低血压。

4.急性心肌梗死、尤其是急性下壁心肌梗死患者,行18导联心电图非常有必要。

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  1. [GetPortalCommentsPageByObjectIdResponse(id=916095, encodeId=6c0e916095dc, content=谢谢分享<a href='/topic/show?id=23e3454e353' target=_blank style='color:#2F92EE;'>#学习#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45473, encryptionId=23e3454e353, topicName=学习)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210112/e0104a6ebb964bb0aff1dcd29eca1748/b07b3c83a01045e7b032a7bfa9bc1a50.jpg, createdBy=fcd55400683, createdName=Yolanda_DO, createdTime=Tue Jan 12 23:27:28 CST 2021, time=2021-01-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=302789, encodeId=dd25302e89a7, content=学习了提高了, beContent=null, objectType=article, channel=null, level=null, likeNumber=101, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/09/21/39b6a0099eb602e8ac1f7e10d5d440a9.jpg, createdBy=dee01724555, createdName=杨利洪, createdTime=Wed Apr 04 22:28:11 CST 2018, time=2018-04-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=296465, encodeId=b14e29646581, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bed62268573, createdName=1219cd1cm72暂无昵称, createdTime=Thu Mar 15 11:43:43 CST 2018, time=2018-03-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=296363, encodeId=c9c5296363eb, content=学习了分享一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/09/21/39b6a0099eb602e8ac1f7e10d5d440a9.jpg, createdBy=dee01724555, createdName=杨利洪, createdTime=Thu Mar 15 06:56:42 CST 2018, time=2018-03-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=296266, encodeId=e0a129626679, content=学习了.谢谢分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2019/12/23/2f51002e1349ccda5be11c1eea1e1e60.jpg, createdBy=a22097948, createdName=天地飞扬, createdTime=Wed Mar 14 23:13:27 CST 2018, time=2018-03-14, status=1, ipAttribution=)]
    2021-01-12 Yolanda_DO

    谢谢分享#学习#

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=916095, encodeId=6c0e916095dc, content=谢谢分享<a href='/topic/show?id=23e3454e353' target=_blank style='color:#2F92EE;'>#学习#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45473, encryptionId=23e3454e353, topicName=学习)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210112/e0104a6ebb964bb0aff1dcd29eca1748/b07b3c83a01045e7b032a7bfa9bc1a50.jpg, createdBy=fcd55400683, createdName=Yolanda_DO, createdTime=Tue Jan 12 23:27:28 CST 2021, time=2021-01-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=302789, encodeId=dd25302e89a7, content=学习了提高了, beContent=null, objectType=article, channel=null, level=null, likeNumber=101, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/09/21/39b6a0099eb602e8ac1f7e10d5d440a9.jpg, createdBy=dee01724555, createdName=杨利洪, createdTime=Wed Apr 04 22:28:11 CST 2018, time=2018-04-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=296465, encodeId=b14e29646581, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bed62268573, createdName=1219cd1cm72暂无昵称, createdTime=Thu Mar 15 11:43:43 CST 2018, time=2018-03-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=296363, encodeId=c9c5296363eb, content=学习了分享一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/09/21/39b6a0099eb602e8ac1f7e10d5d440a9.jpg, createdBy=dee01724555, createdName=杨利洪, createdTime=Thu Mar 15 06:56:42 CST 2018, time=2018-03-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=296266, encodeId=e0a129626679, content=学习了.谢谢分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2019/12/23/2f51002e1349ccda5be11c1eea1e1e60.jpg, createdBy=a22097948, createdName=天地飞扬, createdTime=Wed Mar 14 23:13:27 CST 2018, time=2018-03-14, status=1, ipAttribution=)]
    2018-04-04 杨利洪

    学习了提高了

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=916095, encodeId=6c0e916095dc, content=谢谢分享<a href='/topic/show?id=23e3454e353' target=_blank style='color:#2F92EE;'>#学习#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45473, encryptionId=23e3454e353, topicName=学习)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210112/e0104a6ebb964bb0aff1dcd29eca1748/b07b3c83a01045e7b032a7bfa9bc1a50.jpg, createdBy=fcd55400683, createdName=Yolanda_DO, createdTime=Tue Jan 12 23:27:28 CST 2021, time=2021-01-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=302789, encodeId=dd25302e89a7, content=学习了提高了, beContent=null, objectType=article, channel=null, level=null, likeNumber=101, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/09/21/39b6a0099eb602e8ac1f7e10d5d440a9.jpg, createdBy=dee01724555, createdName=杨利洪, createdTime=Wed Apr 04 22:28:11 CST 2018, time=2018-04-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=296465, encodeId=b14e29646581, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bed62268573, createdName=1219cd1cm72暂无昵称, createdTime=Thu Mar 15 11:43:43 CST 2018, time=2018-03-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=296363, encodeId=c9c5296363eb, content=学习了分享一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/09/21/39b6a0099eb602e8ac1f7e10d5d440a9.jpg, createdBy=dee01724555, createdName=杨利洪, createdTime=Thu Mar 15 06:56:42 CST 2018, time=2018-03-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=296266, encodeId=e0a129626679, content=学习了.谢谢分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2019/12/23/2f51002e1349ccda5be11c1eea1e1e60.jpg, createdBy=a22097948, createdName=天地飞扬, createdTime=Wed Mar 14 23:13:27 CST 2018, time=2018-03-14, status=1, ipAttribution=)]
    2018-03-15 1219cd1cm72暂无昵称

    学习了

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=916095, encodeId=6c0e916095dc, content=谢谢分享<a href='/topic/show?id=23e3454e353' target=_blank style='color:#2F92EE;'>#学习#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45473, encryptionId=23e3454e353, topicName=学习)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210112/e0104a6ebb964bb0aff1dcd29eca1748/b07b3c83a01045e7b032a7bfa9bc1a50.jpg, createdBy=fcd55400683, createdName=Yolanda_DO, createdTime=Tue Jan 12 23:27:28 CST 2021, time=2021-01-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=302789, encodeId=dd25302e89a7, content=学习了提高了, beContent=null, objectType=article, channel=null, level=null, likeNumber=101, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/09/21/39b6a0099eb602e8ac1f7e10d5d440a9.jpg, createdBy=dee01724555, createdName=杨利洪, createdTime=Wed Apr 04 22:28:11 CST 2018, time=2018-04-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=296465, encodeId=b14e29646581, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bed62268573, createdName=1219cd1cm72暂无昵称, createdTime=Thu Mar 15 11:43:43 CST 2018, time=2018-03-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=296363, encodeId=c9c5296363eb, content=学习了分享一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/09/21/39b6a0099eb602e8ac1f7e10d5d440a9.jpg, createdBy=dee01724555, createdName=杨利洪, createdTime=Thu Mar 15 06:56:42 CST 2018, time=2018-03-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=296266, encodeId=e0a129626679, content=学习了.谢谢分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2019/12/23/2f51002e1349ccda5be11c1eea1e1e60.jpg, createdBy=a22097948, createdName=天地飞扬, createdTime=Wed Mar 14 23:13:27 CST 2018, time=2018-03-14, status=1, ipAttribution=)]
    2018-03-15 杨利洪

    学习了分享一下

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=916095, encodeId=6c0e916095dc, content=谢谢分享<a href='/topic/show?id=23e3454e353' target=_blank style='color:#2F92EE;'>#学习#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45473, encryptionId=23e3454e353, topicName=学习)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210112/e0104a6ebb964bb0aff1dcd29eca1748/b07b3c83a01045e7b032a7bfa9bc1a50.jpg, createdBy=fcd55400683, createdName=Yolanda_DO, createdTime=Tue Jan 12 23:27:28 CST 2021, time=2021-01-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=302789, encodeId=dd25302e89a7, content=学习了提高了, beContent=null, objectType=article, channel=null, level=null, likeNumber=101, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/09/21/39b6a0099eb602e8ac1f7e10d5d440a9.jpg, createdBy=dee01724555, createdName=杨利洪, createdTime=Wed Apr 04 22:28:11 CST 2018, time=2018-04-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=296465, encodeId=b14e29646581, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bed62268573, createdName=1219cd1cm72暂无昵称, createdTime=Thu Mar 15 11:43:43 CST 2018, time=2018-03-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=296363, encodeId=c9c5296363eb, content=学习了分享一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/09/21/39b6a0099eb602e8ac1f7e10d5d440a9.jpg, createdBy=dee01724555, createdName=杨利洪, createdTime=Thu Mar 15 06:56:42 CST 2018, time=2018-03-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=296266, encodeId=e0a129626679, content=学习了.谢谢分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2019/12/23/2f51002e1349ccda5be11c1eea1e1e60.jpg, createdBy=a22097948, createdName=天地飞扬, createdTime=Wed Mar 14 23:13:27 CST 2018, time=2018-03-14, status=1, ipAttribution=)]
    2018-03-14 天地飞扬

    学习了.谢谢分享!

    0

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