误诊为重症心肌炎患儿的左室特发性室速1例

A case analysis of idiopathic left ventricular tachycardia misdiagnosed as serious myocarditis

目的分析误诊为重症心肌炎的左室特发性室速患儿的病例资料，探讨其早期诊断和治疗问题。方法回顾性分析1例特发性室速患儿的病例资料。结果上呼吸道感染、运动、紧张、抑郁等均可为诱发原因；无明显诱因时也可发生；发作可表现为突发突止、轻度心悸、心前区不适等症状；亦可表现为持续性发作，依据时间长短不一可出现心悸胸闷头晕，甚至晕厥休克及心功能衰竭，但总体耐受性较好。心电图是诊断该病的主要手段，该例表现为长Q-T间期综合征，电生理检查，提示：室速起源于左后分支。当其难与阵发性室上速鉴别时，可行食管心电图，发现房室分离帮助明确诊断。治疗以营养心肌，抗心律失常，大剂量维生素c、干扰素、丙种球蛋白和激素抑制炎症反应，米力农改善心功能，胺碘酮抗心律失常为主。结论左室特发性室速可通过反复查心肌酶、肌钙蛋白及心电图作出诊断，最后行射频消融术治癔。

Objective To analyze the clinical data of a case of idiopathic left ventricular tachycardia （ILVT） which was misdiagnosed as serious myocarditis and to explore the early diagnosis and treatment of it. Methods The clinical data of the case of ILVT was retrospectively analyzed. Results Upper respiratory tract infection, exercise, mental stress and depression could be the inducing factors of the disease. It may happen without any predisposing causes. The seizure of ILVT manifested by symptoms such as sudden break-out and sudden break-off of the disease, mild palpitation, precordial discomfort, etc. The patient could also suffer sustaining attack with symptoms like palpitations, oppressed feeling in chest, dizziness, and even syncope, shock or heart failure due to various lengths of time. But generally speaking, it was well tolerated. ECG was the primary diagnosing means of this disease. The case manifested long Q-T interval syndrome. Electrophysiologic study showed that ventricular tachycardia originated in the left posterior branch. When it was difficult to distinguish ILVT from paroxysmal supraventricular tachyeardia （PSVT）, esophageal ECG could be used to find atrioventricular dissociation so as to confirm the diagnosis. Nourishing myocardium, treating arrhythmia, inhibiting inflammatory reaction by megavitamin, interferon, gammaglobulin and hormone, improving heart function with milrinone and treating arrhythmia with amiodarone should be the major treatments. Conclusion ILVT can be diagnosed by repeated examining of enzymes, troponin and electrocardiogram and be treated with radiofrequency catheter ablation.