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目的探讨分析多导联持续ST段下移与T波倒置的原因。方法选取2007年2月至2009年6月因不典型胸痛在我院就诊且ECG有持续全导联ST段下移与T波倒置的18例患者,均无心内膜下心肌梗死病史,剔除瓣膜病,电解质紊乱,洋地黄药物影响及脑血管病所致的继发性ST-T变化。随访中常规观察了ECG,超声心动图(UCG),心脏X线片的变化。结果 18例患者中肥厚型心肌病9例,占全组患者的50%,扩张型心肌病4例(22.2%),缩窄性心包炎1例(5.56%),糖尿病2例(11.11%),原因不明T波倒置者2例(11.11%)。在5～15年随访中,除4例扩张型心肌病患者出现左心衰竭外,其余14例均能胜任日常工作,生活,无心肌梗死发生。结论有全导联持续ST段下移与T波倒置的不典型胸痛患者,不要只想到冠心病,应该全面考虑,心肌病所占比例较高,尤其肥厚型心肌病。
Objective To investigate the causes of multi-lead continuous ST-segment down-shift and T-wave inversion. Methods From February 2007 to June 2009, 18 patients with atypical chest pain who were treated in our hospital and whose ECG had continuous ST-segment down-shift and T-wave inversion had no history of subacute myocardial infarction. The valves were excluded Disease, electrolyte imbalance, digitalis drug effects and cerebrovascular disease secondary ST-T changes. During follow-up, ECG, echocardiography (UCG) and changes of cardiac X-ray were routinely observed. Results Among the 18 patients, hypertrophic cardiomyopathy was found in 9 cases, accounting for 50% of all patients, dilated cardiomyopathy in 4 cases (22.2%), constrictive pericarditis in 1 case (5.56%) and diabetes mellitus (11.11%), T wave inversion in 2 cases (11.11%) for unknown reasons. In 5 to 15 years of follow-up, except for 4 cases of dilated cardiomyopathy patients with left heart failure, the remaining 14 cases are capable of daily work, life, no myocardial infarction. CONCLUSIONS: All patients with atypical chest pain continuing ST-segment down-shift and T-wave inversion should not only think of coronary heart disease but should take full account of them. Cardiomyopathy accounts for a high proportion, especially hypertrophic cardiomyopathy.