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目的分析急性单纯后壁心肌梗死(不包括同时合并下壁及右室心肌梗死)的心电图及冠状动脉造影特点。方法总结自2001年至2006年门、急诊收治的急性单纯后壁心肌梗死患者11例,随访心电图特点,并行冠状动脉造影确定梗死相关动脉。结果 11例患者除了 V_7～V_9导联 ST段有典型的弓背向上抬高1.0～2.0mm 外,9例(81.8%)V_1～V_2导联 R/S≥1,5例(45.5%)V_1～V_4导联 ST 段压低1.0～2.0 mm,4例(36.4%)Ⅰ、aVL 导联 ST 段抬高0.5～1.5 mm,5例(45.5%)V_5～V_6导联 ST 段抬高0.5～1.5 mm。冠状动脉造影显示梗死相关动脉均为左回旋支(LCX)。梗死部位1例在第一钝缘支(OM1)发出前,为95%管状狭窄;6例(54.5%)在 OM1发出后,其中4例为100%闭塞,1例为99%次全闭塞,1例为90%长段狭窄;4例(36.4%)在 OM1,其中2例为100%闭塞,1例为99%次全闭塞,1例为95%局限性狭窄。单支病变3例(27.3%),合并左前降支(LAD)病变4例(36.4%),合并右冠状动脉(RCA)病变2例(18.2%),同时合并 LAD 及 RCA 病变2例(18.2%)。结论 12导联心电图,如有 V_1～V_2导联 R/S≥1,V_1～V_4导联 ST 段压低等特点时,结合临床与心肌酶学改变,高度怀疑急性后壁心肌梗死,需做后壁导联和冠状动脉造影加以证实,而梗死相关动脉多为左回旋支。
Objective To analyze the characteristics of electrocardiogram and coronary angiography of acute simple posterior wall myocardial infarction (not including concurrent inferior wall and right ventricular myocardial infarction). Methods From January 2001 to 2006, 11 patients with acute posterior wall myocardial infarction (AMI) admitted to the gate and emergency department were followed up with electrocardiographic features and coronary angiography to determine infarct related arteries. Results Of the 11 patients, R / S≥1,5 (45.5%) were found in 9 cases (81.8%) of V_1 ~ V_2 leads, except for typical ST segment elevation of V_7 ~ V_9. The ST-segment elevation of lead V4 was 1.0-2.0 mm in 4 cases (36.4%), and the ST segment elevation was 0.5-1.5 mm in lead aVL. The ST segment elevation of V5-5 V5 lead was 0.5-1.5 in 5 cases (45.5%) mm. Coronary angiography showed infarct-related arteries were all left circumflex artery (LCX). One case of infarction was 95% tubular stenosis before OM1 was delivered. Six cases (54.5%) were found to be 100% occluded in 4 cases and 99% totally occluded in 6 cases (54.5%), 1 case was 90% long segment stenosis; 4 cases (36.4%) were on OM1, 2 cases were 100% occlusion, 1 case was 99% subtotal occlusion and 1 case was 95% stenosis. There were 3 cases (27.3%) with single vessel disease, 4 cases (36.4%) with left anterior descending coronary artery disease, 2 cases with right coronary artery disease (RCA), 2 cases with LAD and RCA lesion (18.2% %). Conclusions The 12-lead electrocardiogram has a high suspicion of acute posterior myocardial infarction (AMI) in combination with clinical and myocardial enzymatic changes if the V_1-V_2 leads have R / S ≥1 and the V_1-V_4 lead ST-segment depression. Wall lead and coronary angiography to be confirmed, and infarct-related artery mostly left circumflex artery.