著者
Masami Kosuge Toshiaki Ebina Kiyoshi Hibi Kengo Tsukahara Noriaki Iwahashi Satoshi Umemura Kazuo Kimura
出版者
日本循環器学会
雑誌
Circulation Journal (ISSN:13469843)
巻号頁・発行日
vol.78, no.2, pp.483-489, 2014 (Released:2014-01-24)
参考文献数
24
被引用文献数
3 13

Background: Patients with acute pulmonary embolism (APE) often have negative T waves (Neg T) in precordial leads at presentation, but this is also found in acute coronary syndrome (ACS) caused by left anterior descending coronary artery (LAD) disease. Methods and Results: Differences in Neg T on admission electrocardiograms were studied between 107 patients with APE and 248 patients with ACS caused by LAD disease. All patients had Neg T in leads V1–4 and were admitted within 7 days from symptom onset. The number of leads with Neg T (4.8±1.8 vs. 5.5±1.7, P<0.001) and maximum magnitude of Neg T (3.4±2.0 vs. 4.7±3.3mm, P<0.001) were lower in APE. The frequency of occurrence of Neg T in each of the 12 leads, and the precordial lead with the greatest Neg T (peak Neg T) differed between APE and ACS (all P<0.05, respectively). APE was strongly associated with the presence of Neg T in both leads III and V1 and peak Neg T in leads V1–2. The combination of these 2 findings identified APE with 98% sensitivity, 92% specificity, and 94% predictive accuracy, which represented the highest diagnostic accuracy. Conclusions: Among patients with APE and ACS who have precordial Neg T, the presence of Neg T in leads III and V1 and/or peak Neg T in leads V1–2 simply but accurately differentiates APE from ACS.  (Circ J 2014; 78: 483–489)

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Journal club 2014/2/12 病棟の抄読会です。 肺血栓塞栓症の患者さんの心電図では、心筋梗塞や不安定狭心症といった急性冠症候群に似た、前胸部誘導でのT波の陰転化を認めることがあります。陰転化する誘導の部位によって肺塞栓か急性冠症候群かの鑑別ができるかの検討です。 面白い。 中原先生に読んでいただきました。 https://www.jstage.jst.go.jp/article ...

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Pensando nisso, alguns trabalhos tentaram identificar achados no ECG que pudessem diferenciar TEP de IAM! Dentre os achados, dois se destacaram

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