Analysis of electrocardiogram characteristics in patients with hyperacute myocardial infarction

doi:10.3760/cma.j.issn.1007-1245.2024.08.011

Abstract

Abstract:

Objective　To explore the diagnostic value of electrocardiogram in hyperacute myocardial infarction. Methods　A total of 200 patients diagnosed as acute myocardial infarction (AMI) in the chest pain center of Huitong County People's Hospital from January 2018 to March 2023 were selected as the research objects. There were 118 males and 82 females, aged 31 to 65 (48.6±7.5) years. The electrocardiogram manifestations of AMI in hyperacute stage were analyzed, and the time difference between typical electrocardiogram (ECG) pattern of AMI and abnormal myocardial necrosis markers was compared. Paired t test and McNemar-Bowker Pearson Chi-square test were used. Results　Immediately at treatment and 30 min, 1 h, 2 h, 3 h, and 4 h after treatment, the incidences of arrhythmia were 7.0% (14/200), 11.0% (22/200), 36.5% (73/200), 64.0% (128/200), 85.5% (171/200), and 93.0% (186/200), with a statistically significant difference (P<0.001); the incidences of conduction block were 2.5% (5/200), 4.5% (9/200), 11.5% (23/200), 41.5% (83/200), 61.0% (121/200), and 75.5% (151/200), with a statistically significant difference (P<0.001); the incidences of ST segment decline were 37.0% (74/200), 90.0% (180/200), 81.5% (163/200), 77.5% (155/200), 40.0% (80/200), and 5.5% (11/200), with a statistically significant difference (P<0.001); the incidences of low and flat T wave were 40.5% (81/200), 48.5% (97/200), 60.0% (120/200), 83.5% (167/200), 42.0% (84/200), and 15.0% (30/200), with a statistically significant difference (P<0.001). The occurrence time of typical ECG pattern of AMI was longer than that of abnormal markers of myocardial necrosis [(3.86±0.34) h vs. (2.75±0.22) h], with a statistically significant difference (P<0.05). Conclusion　New and frequent arrhythmia, conduction block, ST segment decline, and low and flat T wave in patients with chest pain may be the unique ECG manifestations of hyperacute AMI patients.

Key words:

Myocardial infarction, Hyperacute phase, Electrocardiogram, Diagnostic value

摘要：

目的　探讨急性心肌梗死（AMI）患者超急性期心电图的诊断价值。方法　选取2018年1月至2023年3月在湖南省会同县人民医院胸痛中心确诊的200例AMI患者为研究对象，其中男118例，女82例，年龄31～65（48.6±7.5）岁。分析AMI超急性期的心电图表现，比较AMI典型心电图图形和心肌坏死标志物指标异常出现的时间。采用配对t检验、McNemar-Bowker Pearson卡方检验。结果　就诊即刻、30 min、1 h、2 h、3 h、4 h心律失常发生率依次为7.0%（14/200）、11.0%（22/200）、36.5%（73/200）、64.0%（128/200）、85.5%（171/200）、93.0%（186/200），前后比较差异有统计学意义（P<0.001）；传导阻滞发生率依次为2.5%（5/200）、4.5%（9/200）、11.5%（23/200）、41.5%（83/200）、61.0%（121/200）、75.5%（151/200），前后比较差异有统计学意义（P<0.001）；ST段下移发生率依次为37.0%（74/200）、90.0%（180/200）、81.5%（163/200）、77.5%（155/200）、40.0%（80/200）、5.5%（11/200），前后比较差异有统计学意义（P<0.001）；T波低平发生率依次为40.5%（81/200）、48.5%（97/200）、60.0%（120/200）、83.5%（167/200）、42.0%（84/200）、15.0%（30/200），前后比较差异有统计学意义（P<0.001）。AMI典型心电图图形出现时间（3.86±0.34）h滞后于心肌坏死标志物指标异常出现时间（2.75±0.22）h，差异有统计学意义（P<0.05）。结论　胸痛患者出现新发、频发心律失常、传导阻滞、ST段下移和T波低平改变均可能是超急性期AMI患者特有的心电图表现。

关键词:

心肌梗死, 超急性期, 心电图, 诊断价值

Nie Haihua, Li Maocha, Li Yang.

Analysis of electrocardiogram characteristics in patients with hyperacute myocardial infarction [J]. International Medicine and Health Guidance News, 2024, 30(8): 1282-1285.

聂海华李茂查李阳.

超急性期心肌梗死患者心电图特点分析 [J]. 国际医药卫生导报, 2024, 30(8): 1282-1285.

References

[1] 张师儒,李瑞雪,焦云娣,等.梗死面积对急性ST段抬高型心肌梗死患者预后的预测价值[J].中华内科杂志,2021,60(8):751-756.DOI:10.3760/cma.j.cn112138-20201102-00915.
[2] Cui K, Lyu S, Song X, et al. Effect of coronary collaterals on prognosis in patients undergoing primary percutaneous coronary intervention for acute ST-segment elevation myocardial infarction: a meta-analysis[J]. Angiology, 2018, 69(9):803-811. DOI: 10.1177/0003319718768399.
[3] 曾令军.早期侧支循环建立对于STEMI急诊PCI患者预后的影响[D].大连:大连医科大学,2016.
[4] 李正平,主有峰,韦建瑞.运动康复锻炼对心肌梗死患者循环中内皮祖细胞表达的影响研究进展[J].国际医药卫生导报,2020,26(5):605-609.DOI:10.3760/cma.j.issn.1007- 1245.2020.05.003.
[5] Zeymer U. Diagnosis and initial management of acute myocardial infarction[J]. MMW Fortschr Med, 2019, 161(4):34-36. DOI: 10.1007/s15006-019-0223-3.
[6] 中国医师协会急诊医师分会,国家卫健委能力建设与继续教育中心急诊学专家委员会,中国医疗保健国际交流促进会急诊急救分会.急性冠脉综合征急诊快速诊治指南(2019)[J].中国急救医学,2019,39(4):301-308.DOI:10.3969/j.issn.1002-1949.2019.04.001.
[7] 刘仁光,陈阳.心肌梗死与心电图诊断新标准[J].临床心电学杂志,2012,21(6):441-442.DOI:10.3969/j.issn.1005- 0272.2012.06.014.
[8] 吴杰.急性心肌梗死心电图的规范化诊断[J].临床心电学杂志,2011,20(3):166-168.DOI:10.3969/j.issn.1005-0272. 2011.03.003.
[9] 覃海鸥,卢喜烈,朱金秀.心电图在非持续性ST段抬高型急性冠脉综合征中的作用——基于2020 ESC对该类患者的管理指南[J].实用心电学杂志,2020,29(6):381-385.DOI:10.13308/j.issn.2095-9354.2020.06.001.
[10] Ozawa Y, Kasamaki Y, Iijima K, et al. [Electrocardiographic diagnosis in patients with acute coronary syndrome][J]. Nihon Rinsho, 2006, 64(4):651-666.
[11] 董佳佳,于子翔,赵龙,等.介入治疗与最优药物治疗冠状动脉慢性完全闭塞病变的远期预后对比研究:一项单中心回顾性分析[J].中国循环杂志,2021,36(7):640-645.DOI:10.3969/j.issn.1000-3614.2021.07.003.
[12] Aoyama R, Murata T, Ishikawa J, et al. Case report of non-ST-segment elevation myocardial infarction diagnosed in spectral detector-based computed tomography performed for the diagnosis of acute pulmonary embolism[J]. Eur Heart J Case Rep, 2020, 4(5):1-7. DOI: 10.1093/ehjcr/ytaa284.
[13] Madias JE. The "giant R waves" ECG pattern of hyperacute phase of myocardial infarction. A case report[J]. J Electrocardiol, 1993, 26(1):77-82. DOI: 10.1016/0022- 0736(93)90068-o.
[14] 邹秀娟,杨小波.急性心肌梗死超急性期不典型心电图的表现[J].河北医学,2003,9(11):1001-1003.DOI:10.3969/j.issn.1006-6233.2003.11.021.
[15] 刘红生.急性心肌梗死心电图误诊漏诊原因分析[J].临床医学,2008,28(12):108-109.DOI:10.3969/j.issn.1003-3548. 2008.12.077.
[16] 张克男,李传奇,金景花,等.自主神经系统在心律失常中的作用研究进展[J].延边大学医学学报,2022,45(2):135-139.DOI:10.16068/j.1000-1824.2022.02.015.
[17] 丁绍祥.触发活动致心律失常发生机制的探讨[J].中国循环杂志,2015,30(4):407-409.DOI:10.3969/j.issn.1000-3614. 2015.04.027.
[18] 钟慧,包明威,谭团团,等.心肌梗死后浦肯野纤维电生理特性的异常改变[J].武汉大学学报(医学版),2012,33(3):312-314,326.DOI:10.14188/j.1671-8852.2012.03.008.
[19] 鲍乾坤,杨倩,牟晓峰,等.Wnt/β-catenin信号通路及其在心脏疾病中的作用[J].生理科学进展,2022,53(2):115-120.DOI:10.3969/j.issn.0559-7765.2022.02.007.
[20] 黄东.心电图在急性心肌梗死超急性期诊断中的应用[J].实用心电学杂志,2016,25(4):285-287.DOI:10.13308/j.issn.2095-9354.2016.04.015.
[21] 杨晓云.超急性期T波改变[J].临床心电学杂志,2017,26(1):16-19.DOI:10.3969/j.issn.1005-0272.2017.01.008.
[22] Corlan AD, Horacek M, De Ambroggi L. Susceptibility for ventricular tachycardia and the correlation between depolarization and orthogonal components of repolarization[J]. Anadolu Kardiyol Derg, 2007, 7 Suppl 1:139-141.
[23] Arslan U, Balcioğlu S, Tavil Y, et al. Clinical and angiographic importance of right bundle branch block in the setting of acute anterior myocardial infarction[J]. Anadolu Kardiyol Derg, 2008, 8(2):123-127.
[24] 王威,尹瑞兴,陈泉芳,等.急性心肌梗死超急性期心电图非典型改变的临床特点分析[J].中国全科医学,2014,17(8):931-933.DOI:10.3969/j.issn.1007-9572.2014.08.022.
[25] 赵淑红.ST段抬高型心肌梗死(STEMI)超急性期心电图表现分析[J].中国保健营养(下旬刊),2013,23(4):1654.DOI:10.3969/j.issn.1004-7484(x).2013.04.036.