患者男性,63岁。患者近20年来,发作性心前区剧烈疼痛并向左肩放射近20年,常因劳累而诱发,口含硝酸甘油能使其迅速缓解。心电图各导联均显示心肌严重缺血型改变。诊断为“冠心病”。1987年8月19日因心前区剧烈疼痛,伴夜间阵发性呼吸困难2天入院。体检:心界向左下扩大,律不齐,可闻及早搏10—12次/min。心率76次/min,心音低钝,心尖部可闻Ⅱ级全收缩期吹风样杂音。即时心电图(图1)I—V_1导联均无P波,可见一系列快速宽大畸形的QRS波,由两种形态不同、方向相反的QRS波(R_1和R_2)交替出现所组成,QRS时间分别为0.16和0.14s,R_1-R_2时间与R_2-R_1时间不同,T波方向与QRS主波相反。V_3导联R_2后连续出现4个较宽的形状 Male patient, 63 years old. Patients in the past 20 years, severe paroxysmal acute paroxysm and left shoulder radiation nearly 20 years, often induced by exertion, oral nitroglycerin can make it quickly relieved. ECG lead shows a serious myocardial ischemic changes. Diagnosed as “coronary heart disease.” August 19, 1987 due to acute cardiac pain, with paroxysmal nocturnal dyspnea 2 days admission. Physical examination: heart to expand to the left, irregular, can be heard and premature beats 10-12 times / min. Heart rate 76 beats / min, heart sound low blunt, apex symphysis grade Ⅱ systolic hair-like murmur. There was no P wave in the I-V_1 lead of the real-time electrocardiogram (Figure 1). A series of QRS waves with rapid and large deformities were observed, which were composed of two alternating and opposite QRS waves (R_1 and R_2) 0.16 and 0.14s respectively. The time of R_1-R_2 is different from the time of R_2-R_1, and the direction of T wave is opposite to that of QRS. V_3 lead R_2 after 4 consecutive wide shape