心尖肥厚型心肌病的临床诊断探讨

Clinical diagnosis of apical hypertrophic cardiomyopathy

目的 了解心尖肥厚型心肌病的临床表现和辅助检查特点。方法 总结 2 9例心尖肥厚型心肌病的临床表现和心电图、超声心动图、核素心肌断层显像、运动平板心电图及冠状动脉和左室造影的特征 ,确定心尖肥厚型心肌病的诊断方法。结果 心电图显示以胸导为主的导联R波振幅呈V4 ≥V5>V3 关系增高 ,同时伴有T波对称性深倒置 ,超声心动图和核素心肌断层显像显示心尖部肌肉肥厚 ,2 0例活动平板心电图有心肌缺血 ,左心室造影心尖部肌肉肥厚 ,4例呈“桃形”改变。结论 标准 12导联心电图显示胸导联V3～ 5R波振幅增高伴对称性深倒置T波 ,要高度考虑心肌肥厚型心肌病的可能 ,心电图改变特点是心尖肥厚型心肌病的首要诊断依据。

Objective To evaluate the clinical features of apical hypertrophic cardiomyopahty (AHCM) and the value of ECG for a reliable clinical diagnosis as compared with two dimensional echocardiography. Methods 29 cases with AHCM were studied by with clinical features, ECG, echocardiography, myocadial scanning, coronary angiography and left ventriculography (LVG). Results The major clinical feature of AHCM was myocardial ischemia; ECG showed increased R amplitude and inverted T in chest leads. The increase of R amplitude was in such a pattern that RV 4≥RV 5>RV 3. Thickening of left ventricular apical wall was found with echocardiography and radionuclide myocardial scanning. Exercise electrocardiogram showed myocardial ischemia in 20 cases. LVG and coronary angiography demonstrated apical hypertrophic cardiomyopathy with normal coronary arteries in 16 cases. Conclusion The characteristic inverted T waves and increased R wave amplitude with RV 4≥RV 5>RV 3 in the ECG are the important signs for clinical diagnosis of AHCM.