急性心筋梗塞におけるＳＴ上昇を伴わない増高Ｔ波の臨床的検討

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  • The Clinical Significance of Tall T Wave without ST Elevation on Chest Lead Electrocardiograms.

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To evaluate the clinical significance of a tall T wave without ST elevation, 85 patients with anterior myocardial infarction who were brought to the CCU less than six hours from the onset of chest pain were reviewed. These patients were divided into three types, namely, type A (n=12) had a T wave more than 10mm in height without ST elevation; type B (n=21) had ST elevation of more than 2mm; type C (n=52) had a dome shaped or plateau ST segment. 25% of type A, 33% of type B and 50% of type C patients had a history of angina pectoris. In type A, the degree of chest pain at onset of myocardial infarction (MI) was greater than in the other types. The first ECG tracing was made 1.6hr (type A), 2.4hr (type B) and 2.6hr (type C) after onset of MI, and the first CPK concentration was 112IU/l (type A), 347IU/l (type B) and 522IU/l (type C). There was a significant difference between type A and the other types. The peak CPK concentration was similar in the 3 types and the time of the peak CPK was 12.6hr (type A), 17.6hr (type B) and 18.0hr (type C). There was a significant difference between type A and the other types. In type A, the mortality rate was 41.7%, but the clinical course of the survivors was better than in the other types. Angiographic findings one month later revealed no total occlusion and no collaterals to the LAD lesion. As a consequence it follows that the shorter the time to peak CPK, the better was the clinical course of the survivors. Angiographically there was no total occlusion, and the culprit lesion of type A was reperfused by internal treatment. We believe type A has a smaller degree of myocardial ischemia before MI for the reason that the rate of a history of angina pectoris was lower, the symptom at onset of MI was more severe and angiographically there was no collateral.

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