心得安试验加重ST—T改变l例

患者女性，50岁。2001－07—11因子宫肌瘤人院。平素无心慌、胸闷及其他病史。检查：血压150／100mmHg(20／13．3kPa)。常规心电图示：Ⅱ、Ⅲ、aVF导联ST段略压低，V4—V6导联T波呈负正双向(图1)。即给予心得安20mg口服后90min做心电图鉴别试验。结果，心率由试验前的90次／min，降为68次／min，T波I、aVL导联由直立变为倒置，aVR导联T波变直立，原来压低的ST段Ⅱ、Ⅲ、aVF较前明显降低．且T流Ⅱ、Ⅲ、aVF由直立变为负正双向，TV4-V6由负正双向变为倒置(图2)。3d后重复上述试验检查，结果与首次试验相同。     

浅谈非特异性T波改变的认识

心电图ST—T波改变有一定的临床价值。j点下移<20mv没有价值,>20mv有参考价值,而ST段呈水平型或下垂型压低0.05mv以内,有参考意义,>0.05mv有病理意义。单纯T波改变更不能肯定为病理性的,尤其Ⅱ、Ⅲ、aVF导联的T波改变或伴有ST段的改变,甚至在胸导联出现上述异常,不能轻易诊断     

非Q波急性前壁心肌梗死1例

患者女性，83岁，因脚痛件冷汗2小时，门诊诊断急性心肌梗死。入院急查心电图（图1）；Ⅱ．Ⅲ.aVF导联ST段下移0.5mm－1．5mm，aVR上抬0．5min。胸导联V1－V4ST段均上抬，其中以V2－V4抬高明显，高达5mm，T波高耸，呈典型超急期ST－T改变。化验室急查心肌酶谱有增高，（肌酸激酶↑272．0iu／L，乳酸脱氢酶↑252．0iu／L，肌酸激酶同功酶↑20．8iu／L，CKMB／CK↑0.08，羟丁酸脱氨酶180．0iu／L）。立即用硝酸甘油舌下含服，肌注杜冷丁50mg，经以上治疗后，于当晚7时心电图示（图2）：目．豆．aVFST段下移消失，但T波表现为平坦…     

心电图在鉴别急性肺栓塞与非ST段抬高型急性冠脉综合征中的价值探讨

目的评价床旁12导联ECG在鉴别急性肺栓塞(Acute pulmonary embolism,APE)和非ST段抬高型急性冠脉综合征(acute coronary syndrome,NSTE-ACS)中的价值。方法回顾性研究我院2010年1月～2011年10月连续收治的80例APE患者和40例NSTE-ACS患者。对两组患者入院时的ECG进行组间比较。结果右束支传导阻滞(RBBB)及S1Q3T3改变在两组间发生率无显著性差异,分别是APE(8例,10%)/NSTE-ACS(5例,13%)和APE(21例,26%)/NSTE-ACS(6例,15%)。而V1～3T波倒置同时伴有Ⅱ、Ⅲ、aVF导联T波倒置在APE组明显增多,阳性预测价值和特异性分别是83%和85%。结论右束支传导阻滞(RBBB)及S1Q3T3对于鉴别APE和NSTE-ACS没有帮助,而V1～3同时伴有Ⅱ、Ⅲ、aVF导联T波倒置是APE较特异的心电图表现。     

食蟹猴心电图研究

目的 研究食蟹猴在清醒状态下的心电图特点,为食蟹猴在药物临床前安全性评价实验研究中的应用提供参考.方法 选择72只2～3岁食蟹猴,体重2.5～3.5 kg,雌雄各36只.在环境安静、动物清醒状态下,测定Ⅰ、Ⅱ、Ⅲ、aVR、aVL、aVF 6个导联的心电图变化,并计算平均心率,P波、QRS波群和T波的振幅,PR间期、QT间期等指标.结果 72只食蟹猴均为窦性心律,并发现在肢体Ⅱ导联中,P波均为向上直立波,Ⅱ、Ⅲ、aVF导联中大部分食蟹猴没有S波,aVR导联中大部分食蟹猴没有Q波.食蟹猴P波较尖,振幅较小,QRS波群多样化,QT间期的K值范围是0.302±0.040,ST段位于等电位线,T波以圆滑为主,Ⅱ导联中绝大部分为直立.结论 此研究建立了食蟹猴心电图基础数据,为相关的研究提供了参考.     

心电图QRS综合波改变对早期诊断急性下壁心肌梗死的意义

目的通过胸痛患者连续心电图监测,以便早期确诊急性下壁心肌梗死。方法在30例患者中,根据胸痛开始5h内连续描记常规12个导联心电图,测定各导联R波、S波振幅及ST段变化,与心肌梗死前正常心电图作比较。结果所记录的心电图改变中,Ⅱ、Ⅲ、aVF导联QRS波群的S波消失,出现高尖R波,下壁心肌梗死aVL导联S波的改变也有重要诊断意义。结论急性下壁心肌梗死早期心电图最显著的改变,表现在Ⅲ、aVF、aVL导联QRS综合波终末电压的增高。     

不完全性心房内传导阻滞2例报告

本文报道2例不完全性心房内传导阻滞,并对其机理进行初步分析。例1,男性,52岁,肺心病患者,心电图见图1。入院当天心电图呈窦性心律,P-R间期,R-R间期固定,ST段下垂型压低,T波倒置。Ⅲ导联P波时限0.08秒,振幅0.10mv,P-R间期0.12秒,aVF导联见双峰P波,P波时限0.12秒,峰间距0.06秒。入院后29天描记心电图,见Ⅲ导联P波时限0.08秒,振幅增至0.35mv,aVF导联双峰P波消失,出现P波高尖,     

芸豆中毒致急性心肌梗死1例报告

患者，男，27岁，工人，于11h前因食用未熟的芸豆后出现全身皮肤发红，伴有头晕、恶心、胸闷、出冷汗，于2008年1月15日来我院就诊，在门诊给予马来酸氯苯那敏、地塞米松等抗过敏药物治疗，无明显疗效，1h后患者突然出现剧烈胸痛、大汗淋漓，心电图示Ⅱ Ⅲ aVF V1-5导联出现梗死性Q波，ST段弓背向上抬高与T波连成单向曲线。     

心得安试验加重ST-T改变1例

患者女性,50岁.2001-07-11因子宫肌瘤入院.平素无心慌、胸闷及其他病史.检查:血压150/100mmHg(20/13.3kPa).常规心电图示:Ⅱ、Ⅲ、aVF导联ST段略压低,V4～V6导联T波呈负正双向(图1).即给予心得安20mg口服后90min做心电图鉴别试验.     

早期复极综合征一例报告

刘××,男,28岁。因心悸、胸闷痛、气短,门诊心电图示:Ⅱ、Ⅲ、avF 的 ST 段抬高,疑为“心绞痛、“心梗”?于1991年12月13日入院。查体:血压12/8kpa、脉搏60次/分、心肺检查无异常;肝脾不大;常规化验:SG-OT 及其它生化检查均正常。X 线、超声心动图无异常发现。多次心电图检查均为:窦性心律,Ⅱ、Ⅲ、avF、V_2—V_5ST 段呈凹面向上抬高(弓背向下),幅度0.05—0.25mv,V_2—V_4T 波两支对称高耸(见图1)。用消心痛、丹参加低分子右旋糖酣静滴等治疗无效。床傍下蹲30次后立即作心电图(见图2),ST 段抬高的导联(Ⅱ、Ⅲ、aVF、V_2—V_6),回到等电线。T 波无明显变化。诊断:早期复极综合征。     

普萘洛尔试验在鉴别中青年女性肿瘤患者心电图ST-T 改变性质中的应用

目的探讨普萘洛尔试验在鉴别未经治疗的中青年女性肿瘤患者心电图ST-T改变性质中的临床应用价值。方法选择154例年龄18～49岁,心电图具有非特异性ST-T改变,心率>80bpm的女性为研究对象,其中78例肿瘤患者标记为A组,76例健康女性标记为B组。在给予口服普萘洛尔20mg后,分别在30min、60min、120min记录心电图,比较服药后两组心电图ST-T的变化。结果 A组普萘洛尔试验阳性67例,阳性率为85.9%;B组普萘洛尔试验阳性70例,阳性率达92.1%,两组之间的差异无统计学意义(P>0.05)。结论普萘洛尔试验可以用于鉴别未经治疗的中青年女性肿瘤患者心电图ST-T改变的性质,与其应用于健康女性具有相似的临床价值。     

血钾紊乱心电图异常及临床意义

目的总结血清钾离子紊乱的常见心电图异常并探讨其临床意义。方法回顾分析临床证实血清钾离子紊乱且有心电图异常的78例患者临床资料。结果 69例低血钾患者U波增高者56例,Q-T间期延长者54例,ST-T改变41例,T波改变46例,另有8例患者出现心律失常。9例高血钾患者中6例出现高尖、帐篷状T波改变,4例QRS波明显增宽,3例患者出现窦性心动过缓,1例发生窦-室传导。结论心电图可作为诊断血钾紊乱的重要辅助手段,帮助临床医师及时纠正血钾紊乱、避免血钾紊乱引起的各种严重心律失常。     

Effects of calcium antagonists on the alternation of the ST-T complex and associated conduction abnormalities during coronary occlusion in dogs.

1 The effects of Ca2+ -antagonists on the relationships between alternate changes in the ST-T complex in the epicardial electrogram, ST-T alternans, and associated excitation-conduction abnormalities during coronary occlusion were examined in anaesthetized dogs. 2 Epicardial unipolar electrograms, bipolar electrograms (BPEG) and monophasic action potentials (MAP) were recorded with unipolar, composite and suction electrodes, respectively. 3 ST-T alternans was associated with serious conduction delay. During the period of ST-T alternans, the amplitude of MAP changed alternately and the negative deflection of the ST-T complex was associated with a larger MAP. A depression of the TQ level and decrease in the resting potential of MAP were marked. 4 Verapamil (0.2 mg/kg) and diltiazem (0.5 mg/kg) inhibited ST-T alternans, conduction abnormalities, TQ depression and changes in MAP. However, after these drugs, the TQ depression and the decrease in the resting potential were evident after a longer period of occlusion at a time when ST-T alternans, conduction abnormalities and alternate changes in MAP were still inhibited. Dipyridamole (0.5 mg/kg) had no effect on either ST-T alternans or the conduction abnormalities. 5 Verapamil and diltiazem inhibited ST-T alternans and the associated excitation and conduction abnormalities. The effects of these two drugs cannot be explained on the basis of attenuation of the decrease in the resting potential.     

Long QT and ST-T change associated with organophosphate exposure by aerial spray

The relation between the electrocardiographic manifestation and the subjective symptoms accompanying organophosphate pesticide exposure caused by aerial spray was investigated. The study included 39 patients with a diagnosis of organophosphate poisoning, who visited A-clinic within 24h of exposure to aerial spray of organophosphate pesticide in Gumma Prefecture, from July 2001 to September 2001. Ages ranged from 3 to 82 years. Thirty-five patients were female. Three were diagnosed as severe, 11 moderate, and 25 mild, judged from the score of subjective symptoms. Electrocardiographic abnormalities were bradycardia (<50) 2; prolonged PQ interval 4; prolonged QTc interval (>430ms) 22; nonspecific ST-T change 35; supraventricular arrhythmia 13; and ventricular premature complex with R on T 1. Prolonged QTc interval developed in 2-3 severe cases, 4-11 moderate cases, and 16-25 mild cases. QT prolongation, ST-T change and arrhythmia were detected for some patients exposed to organophosphate by aerial spray.     

急性脑血管疾病的心电图变化

急性脑血管疾病是临床常见病,临床表现复杂多变,其引起的心脏电学改变也复杂多变.心电图异常改变主要包括心律异常、传导异常、复极异常、房室改变,其中又以复极异常中的ST-T改变为主.     

168例青年人心电图ST-T异常临床诊断价值

目的探讨青年人心电图ST-T异常临床诊断价值。方法观察168例青年人心电图ST-T异常者通过相关检查后诊断为器质性病变的人数变化。结果最后确认缺血性ST-T改变11例,而其他155例均属功能性改变。结论对心电图ST-T异常的病例不能盲目下心肌缺血等诊断,应结合临床综合判断。     

芪参益气滴丸对冠心病病人体表心电图ST-T的影响

目的：观察芪参益气滴丸对冠心病病人体表心电图ST-T的影响。方法：2006年1月～2008年9月124例确诊为冠心病的门诊病人,口服芪参益气滴丸0.5g,1日3次,连用30天,观察用药前后心电图改变。结果：治疗后缺血型ST-T明显改善,总有效率为80.95%,P〈0.05。结论：芪参益气滴丸能够明显减轻冠心病病人的心肌缺血,改善心功能,提高生活质量和运动耐量。     

Electrocardiographic abnormalities in acute heroin overdosage

Twenty-one 25 acutely overdosed heroin addicts had abnormalities noted on their admission electrocardiograms. The most common findings were nonspecific ST-T changes in 17 patients, sinus tachycardia in 11, and left or right atrial enlargement in 8. Five patients had more serious arrhythmias (4 atrial fibrillation and 1 ventricular tachycardia). For the entire group the initial PaO2 was 74.8 +/- 48.2 torr. This degree of oxygenation was only achieved with the use of high dose supplemental oxygen. The 5 patients with the more serious arrhythmias had comparable PaO2s but this was only achieved with higher supplemental oxygen concentrations. We conclude that electrocardiographic alterations (other than arrhythmias) are very common in acute heroin overdosage and may be related to hypoxemia. The abnormal cardiac rhythms may be due to the direct effects of heroin or its metabolites. Heroin addiction is associated with a multitude of medical complications which can affect various organ systmes including the heart (1). Within the last six years several reports have appeared documenting electrocardiographic abnormalities in heroin users (2-5). These studies dealt with either a small series of patients or patients who used methadone or heroin in a chronic fashion. No one, to our knowledge, has extensively studied the electrocardiographic changes which occur in patients with acute heroin overdosage. This retrospective analysis of the electrocardiograms (ECG), arterial blood gases and selected electrolytes in 25 consecutively hospitalized patients acutely overdosed on heroin is an attempt to correct this deficiency.     

Bioequivalence of endogenous substances facing homeostatic equilibria: an example with potassium

Oral administration of endogenous substances in most cases results in negligible net increases in baseline plasma concentrations, associated with high variability. This poses the problem of their bioequivalence. Using the data obtained from a bioequivalence investigation of potassium aspartate (test vs reference formulation), the authors demonstrate the inconsistency of bioequivalence based on plasma concentrations and standard methods. Potassium aspartate was given orally at a dose of 15.8 mmoles to 12 healthy volunteers as test and reference values according to a two-period, two-formulation, two-sequence design. The individual net values of the area under the curve of plasma concentration (AUC) and cumulative urinary excretion (CUE), both obtained with the test formulation as post-dose minus baseline, were multiplied by 2, 3, 4, 5 and 6 and added to the baseline in order to simulate the administration of increasing single doses of the test, assuming dose-linear kinetics. Data generated with the test formulation were compared with original data of the reference according to 90% confidence intervals. With AUC, bioequivalence of test and reference formulations was demonstrated with 1 : 1, 2 : 1 and 3 : 1 test to reference dose ratios. With CUE only the 1 : 1 dose ratio comparison produced bioequivalence. The authors conclude that bioequivalence of endogenous substances conducted with standard procedures in most cases is a useless exercise. With potassium and more generally with drugs cleared via urine, urinary excretion would reflect the extent of absorption more faithfully than AUC.     

Toxicity of potassium cyanide added to fresh fruit and juice

To investigate the toxicity of potassium cyanide in fresh fruit and juice, male and female Wistar rats were orally dosed with fruit homogenates or juices containing 3 x LD50 of potassium cyanide. These were given in single doses at various intervals after spiking. The dosing solutions were analysed for cyanide using a cyanide test kit. There was a good correlation between the toxic signs in rats and the cyanide remaining in dosing solutions. The toxicity of spiked apple and honeydew melon diminished with time, while spiked grape and both grape and apple juices maintained their toxicity during the 4-hr studies. The pH of the samples both before and after spiking seemed to be an important factor in determining the toxicity.