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病例分享：Wellens综合征，一定要警惕这种可能致命的心电图异常！

2018-01-27 许迪 黄元铸 中国医学论坛报今日循环

Wellens综合征心电图异常
关注

1例54岁女性患者，突发胸痛，舌下含服硝酸甘油后疼痛缓解，入院心电图如下。

1例54岁女性患者，突发胸痛，舌下含服硝酸甘油后疼痛缓解，入院心电图如下。



心电图诊断

1. 窦性心律，心率85次/分；

2. 不完全性右束支传导阻滞；

3.Ⅰ、Ⅱ、avL、avF、V3-V6导联T波倒置。

提示

1. 1982年，韦伦斯（Wellens）团队描述了胸前导联（主要在V3、V4或V2-V4导联）的两种异常T波形态，并指出该类T波改变对提示左前降支（LAD）近端严重狭窄病变具有高度特异性。其中常见的形态改变是深倒的对称T波，如本例所示；另一种较少见的形态改变是双相T波。上述导联T波异常也被称为Wellens综合征。

2. Wellens综合征主要发生于冠心病患者疼痛缓解期（无症状时），该类患者易在该时期发生较大面积心肌梗死。药物治疗通常无法防止心肌梗死或死亡的发生，经皮冠脉介入治疗（PCI）是目前针对Wellens综合征最有效的治疗方法。

3. 一旦发现该类患者，应尽早行冠脉造影。本例患者诊断后及时接受冠脉造影检查，发现LAD近端存在大于90%的阻塞病变，并成功施行了血管成形和支架置入术。

4. 某些非缺血性心脏病如心肌病等也可出现相似的心电图改变，故诊断Wellens综合征必须结合临床表现，即有心绞痛病史且在无症状时出现上述心电图改变者，才可考虑Wellens综合征诊断！

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    2018-11-11 xinmeili

    #Wellens综合征#

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=1643059, encodeId=31031643059db, content=<a href='/topic/show?id=9afb1866076' target=_blank style='color:#2F92EE;'>#Wellens综合征#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=18660, encryptionId=9afb1866076, topicName=Wellens综合征)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d76323086745, createdName=xinmeili, createdTime=Sun Nov 11 20:31:00 CST 2018, time=2018-11-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=283142, encodeId=630328314227, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=8, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b4b12216028, createdName=120e71dcm28暂无昵称, createdTime=Mon Jan 29 09:26:53 CST 2018, time=2018-01-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1431093, encodeId=423e143109384, content=<a href='/topic/show?id=f9b9e9124a8' target=_blank style='color:#2F92EE;'>#综合征#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79124, encryptionId=f9b9e9124a8, topicName=综合征)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Mon Jan 29 06:31:00 CST 2018, time=2018-01-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1629719, encodeId=dc941629e191f, content=<a href='/topic/show?id=7d5b51209d6' target=_blank style='color:#2F92EE;'>#心电图异常#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51209, encryptionId=7d5b51209d6, topicName=心电图异常)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c1e521353098, createdName=医生2401, createdTime=Mon Jan 29 06:31:00 CST 2018, time=2018-01-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=282594, encodeId=f39a2825940a, content=好文章.学习了.临床注意., beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=60791943465, createdName=1e0f8808m18(暂无匿称), createdTime=Sat Jan 27 15:47:41 CST 2018, time=2018-01-27, status=1, ipAttribution=)]
    2018-01-29 120e71dcm28暂无昵称

    学习了

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1643059, encodeId=31031643059db, content=<a href='/topic/show?id=9afb1866076' target=_blank style='color:#2F92EE;'>#Wellens综合征#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=18660, encryptionId=9afb1866076, topicName=Wellens综合征)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d76323086745, createdName=xinmeili, createdTime=Sun Nov 11 20:31:00 CST 2018, time=2018-11-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=283142, encodeId=630328314227, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=8, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b4b12216028, createdName=120e71dcm28暂无昵称, createdTime=Mon Jan 29 09:26:53 CST 2018, time=2018-01-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1431093, encodeId=423e143109384, content=<a href='/topic/show?id=f9b9e9124a8' target=_blank style='color:#2F92EE;'>#综合征#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79124, encryptionId=f9b9e9124a8, topicName=综合征)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Mon Jan 29 06:31:00 CST 2018, time=2018-01-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1629719, encodeId=dc941629e191f, content=<a href='/topic/show?id=7d5b51209d6' target=_blank style='color:#2F92EE;'>#心电图异常#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51209, encryptionId=7d5b51209d6, topicName=心电图异常)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c1e521353098, createdName=医生2401, createdTime=Mon Jan 29 06:31:00 CST 2018, time=2018-01-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=282594, encodeId=f39a2825940a, content=好文章.学习了.临床注意., beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=60791943465, createdName=1e0f8808m18(暂无匿称), createdTime=Sat Jan 27 15:47:41 CST 2018, time=2018-01-27, status=1, ipAttribution=)]
    2018-01-29 zhouqu_8

    #综合征#

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1643059, encodeId=31031643059db, content=<a href='/topic/show?id=9afb1866076' target=_blank style='color:#2F92EE;'>#Wellens综合征#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=18660, encryptionId=9afb1866076, topicName=Wellens综合征)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d76323086745, createdName=xinmeili, createdTime=Sun Nov 11 20:31:00 CST 2018, time=2018-11-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=283142, encodeId=630328314227, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=8, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b4b12216028, createdName=120e71dcm28暂无昵称, createdTime=Mon Jan 29 09:26:53 CST 2018, time=2018-01-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1431093, encodeId=423e143109384, content=<a href='/topic/show?id=f9b9e9124a8' target=_blank style='color:#2F92EE;'>#综合征#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79124, encryptionId=f9b9e9124a8, topicName=综合征)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Mon Jan 29 06:31:00 CST 2018, time=2018-01-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1629719, encodeId=dc941629e191f, content=<a href='/topic/show?id=7d5b51209d6' target=_blank style='color:#2F92EE;'>#心电图异常#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51209, encryptionId=7d5b51209d6, topicName=心电图异常)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c1e521353098, createdName=医生2401, createdTime=Mon Jan 29 06:31:00 CST 2018, time=2018-01-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=282594, encodeId=f39a2825940a, content=好文章.学习了.临床注意., beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=60791943465, createdName=1e0f8808m18(暂无匿称), createdTime=Sat Jan 27 15:47:41 CST 2018, time=2018-01-27, status=1, ipAttribution=)]
    2018-01-29 医生2401

    #心电图异常#

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1643059, encodeId=31031643059db, content=<a href='/topic/show?id=9afb1866076' target=_blank style='color:#2F92EE;'>#Wellens综合征#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=18660, encryptionId=9afb1866076, topicName=Wellens综合征)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d76323086745, createdName=xinmeili, createdTime=Sun Nov 11 20:31:00 CST 2018, time=2018-11-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=283142, encodeId=630328314227, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=8, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b4b12216028, createdName=120e71dcm28暂无昵称, createdTime=Mon Jan 29 09:26:53 CST 2018, time=2018-01-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1431093, encodeId=423e143109384, content=<a href='/topic/show?id=f9b9e9124a8' target=_blank style='color:#2F92EE;'>#综合征#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79124, encryptionId=f9b9e9124a8, topicName=综合征)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Mon Jan 29 06:31:00 CST 2018, time=2018-01-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1629719, encodeId=dc941629e191f, content=<a href='/topic/show?id=7d5b51209d6' target=_blank style='color:#2F92EE;'>#心电图异常#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51209, encryptionId=7d5b51209d6, topicName=心电图异常)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c1e521353098, createdName=医生2401, createdTime=Mon Jan 29 06:31:00 CST 2018, time=2018-01-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=282594, encodeId=f39a2825940a, content=好文章.学习了.临床注意., beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=60791943465, createdName=1e0f8808m18(暂无匿称), createdTime=Sat Jan 27 15:47:41 CST 2018, time=2018-01-27, status=1, ipAttribution=)]
    2018-01-27 1e0f8808m18(暂无匿称)

    好文章.学习了.临床注意.

    0