经典肺栓塞心电图1例

2019-10-28 卢妙 许迪 黄元铸 中国医学论坛报今日循环

经典肺栓塞心电图1例

1例65岁男性患者,胸痛伴严重呼吸困难3天,症状逐渐加重,心电图如下。



心电图诊断:1.窦性心动过速;2.电轴右偏;3.不完全性右束支传导阻滞;4.呈SⅠQⅢTⅢ图形;5.Ⅱ、Ⅲ、aVF与V1-V4导联T波均倒置。

【提示】

1.本例患者的心电图充分反映了急性大面积肺动脉栓塞(肺栓塞)的所有特征表现,包括以下几点:①窦性心动过速;②电轴右偏;③右束支传导阻滞;④SⅠQⅢTⅢ图形;⑤下壁与胸前导联同时出现T波倒置。

2.大面积肺栓塞患者也常出现急性右室超负荷和扩张(右心室重构),可出现:①不完全性或完全性右束支传导阻滞;②下壁Ⅲ和aVF导联出现异常Q波(而发生下壁心梗时,Ⅱ、Ⅲ与aVF导联均有Q波,且宽度常>0.04秒);③下壁及胸前导联同时出现T波倒置亦常见于急性肺栓塞。

3.该患者入院后行超声检查提示下肢深静脉血栓,胸部CT肺血管造影证实存在大面积肺梗死。

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  2. [GetPortalCommentsPageByObjectIdResponse(id=1950437, encodeId=7b02195043e28, content=<a href='/topic/show?id=a1c182130d0' target=_blank style='color:#2F92EE;'>#肺栓塞心电图#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82130, encryptionId=a1c182130d0, topicName=肺栓塞心电图)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3c5e117, createdName=lujian, createdTime=Thu Apr 02 18:05:00 CST 2020, time=2020-04-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=377553, encodeId=f7823e755371, content=昨天值班就遇到一个经典心电图的肺栓塞, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f4fd2501610, createdName=1249dbd4m90暂无昵称, createdTime=Sun Dec 29 09:11:01 CST 2019, time=2019-12-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=374535, encodeId=37703e4535d8, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2019/10/28/bf08ae68063ce2655d131c9750dca493.jpg, createdBy=aa9a5216866, createdName=z6125, createdTime=Mon Oct 28 20:23:13 CST 2019, time=2019-10-28, status=1, ipAttribution=)]
    2019-12-29 1249dbd4m90暂无昵称

    昨天值班就遇到一个经典心电图的肺栓塞

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  3. [GetPortalCommentsPageByObjectIdResponse(id=1950437, encodeId=7b02195043e28, content=<a href='/topic/show?id=a1c182130d0' target=_blank style='color:#2F92EE;'>#肺栓塞心电图#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82130, encryptionId=a1c182130d0, topicName=肺栓塞心电图)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3c5e117, createdName=lujian, createdTime=Thu Apr 02 18:05:00 CST 2020, time=2020-04-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=377553, encodeId=f7823e755371, content=昨天值班就遇到一个经典心电图的肺栓塞, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f4fd2501610, createdName=1249dbd4m90暂无昵称, createdTime=Sun Dec 29 09:11:01 CST 2019, time=2019-12-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=374535, encodeId=37703e4535d8, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2019/10/28/bf08ae68063ce2655d131c9750dca493.jpg, createdBy=aa9a5216866, createdName=z6125, createdTime=Mon Oct 28 20:23:13 CST 2019, time=2019-10-28, status=1, ipAttribution=)]
    2019-10-28 z6125

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