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Acute myocardial infarction after diagnostic criteria partitions Discussion


inJCardiol, May2003, Vo1.31No. 5I-HIaVR-aVFVl3V4-6V7-9VZR a 5R} key. Canton only l -. JL. - A circle 3A V Vl lead electrocardiogram showed the most significant sT-segment elevation (> 4ram) showed anteroseptal, septal Figure 3B, after a show in Example 3, ECG, and identified Tc. Resting MIBI myocardial perfusion imaging (short axis) results lesion, the distal right coronary artery from the descending branch after the collateral flow, circumflex obtuse marginal branch in 90% showed the limitations of the narrow opening,[link widoczny dla zalogowanych], then the line PCI treatment, respectively, the former descending, circumflex artery and right coronary artery who each have a stent, with satisfactory results after surgery, angina pectoris symptoms disappeared completely,[link widoczny dla zalogowanych], PCI postoperative resting Tc. MIBI myocardial perfusion imaging showed inferior wall and posterior septal defects in radionuclide distribution significantly, anteroseptal radionuclide sparse. According to Horan septal positioning discussed zoning laws ..., V,[link widoczny dla zalogowanych], and Ⅲ lead after the partitions corresponding to a relatively accurate, but under the wall by the lead Ⅲ electrical activity of the heart, so the best response to V lead after the electrical activity of the heart conduction partitions Union. This leads sT V 4 patients were significantly elevated section, and the sT elevation range of performance for the V1> V2> V3 and V1> V3R> V4R, these features can be used with anteroseptal AMI,, sT elevation V> V and right ventricular AMI, V3R or V4R> V1 are apparently different. 3J. The IRA were 4 patients with right coronary artery, rather than the anterior descending, so V lead ST-segment elevation AMI is not due before the partitions, resting TC. MIBI myocardial perfusion imaging also shows characteristics of post-septal myocardial infarction. Therefore, we propose the ECG diagnosis of AMI after the partitions are as follows: (1) V inferior wall AMI is accompanied by ST segment was elevated significantly in lead I> 2mm; (2) ST segment elevation range was V1> V2> V3 and V1> V3R> ; V4R. Based on the above two points can be diagnosed after the merger for the next wall partitions AMI, this time should not be diagnosed as anteroseptal AMI, should not be considered separately due to right ventricular AMI J,[link widoczny dla zalogowanych], is diagnosed with a right ventricular myocardial infarction, the study failed to provide sufficient evidence. From the perspective of coronary artery anatomy and right ventricular posterior wall of the right coronary artery blood supply mainly from the posterior branch of right ventricle, usually with 3-4 branches smaller, rarely reach the remote site after the partitions, and then partitions mainly by the right coronary descending branch of the septal artery branch after the blood supply, so that only the proximal right coronary artery occlusive disease may also result in only the right room, and after the partitions of the AMI, but according to this data,[link widoczny dla zalogowanych], in the same period due to inferior or posterior inferior wall + Merge right ventricular AMI patients admitted to hospital 109 cases with only 7 and asked the wall AMI, prompted partitions the incidence of AMI was significantly lower than the right ventricular inferior wall and the incidence of AMI, suggesting that the incidence rate may be related to the following factors: ① After the partitions, although the main right coronary artery from the descending branch of the interventricular septum after posterior branch of the blood supply, but more with the end in the blood vessels of the septal anterior descending artery anastomosis formation of the anterior branch network, so the partitions after the implementation of the dual blood supply. This 4 cases, 3 cases of anterior descending branch of chronic total occlusion, left anterior descending artery in the distal right coronary artery from the descending branch after the branch through the interventricular septum after septal anterior branch of the collateral circulation, so when the right coronary acute arterial occlusion, is easy to create partitions after AMI. ② When the posterior wall AMI occurs when the septal AMI, may be offset by the sT V segment elevation in lead, so at this time AMI after the partitions may be hidden. ③ When the right coronary artery there is a large right ventricular branch also provides post-right ventricular septal wall and the blood of complete occlusion of the proximal end of the branch which can result in right ventricular septal and post-AMI, however, the incidence of this anatomic variation is extremely low.