心室壁心肌肿瘤的临床和心电图特点

Clinical and Electrocardiographic Features of Ventricular Intramural Tumor

目的 :总结心室壁心肌肿瘤的临床和心电图特点 ,意旨早期诊断。 方法 :对 1992年 12月～ 1999年 7月 5例经心脏影像检查发现并经手术和病理证实的心室壁心肌肿瘤患者的临床和心电图特点进行总结分析。 结果 :本组 5例经病理证实为心室壁心肌肿瘤 ,其中 ,左心室心肌海绵体瘤 ,脂肪瘤、浸润性脂肪瘤、左心室和双心室心肌纤维瘤各 1例。 5例均以室性心动过速 (VT)为首发临床表现 ,心室率在 16 0～ 2 0 0次 /分 ;心电图 (ECG)均有酷似心肌梗塞改变 ,包括异常 Q波 2例 ,ST段抬高 2例 ,T波深度倒置 5例 ,又均无明确的心肌梗塞史 ;而且 ,肿瘤部位与 ECG异常所在导联和 VT起源部位基本一致 ,其中 1例经心内电生理证实。 结论 :1对临床上以 VT为主要表现 ,并有 ECG酷似心肌梗塞改变又无明确心肌梗塞病史的患者 ,应高度疑诊为心室壁心肌肿瘤 ,并行影像学检查确诊。 2 ECG示酷似心肌梗塞所累及导联和

Objective:To summarize the clinical and electrocardiogram (ECG) features of ventricular intramural tumor,facilitating early diagnosis and treatment. Methods:The clinical and ECG features of ventricular intramural tumor detected with cardiac image examinations,and confirmed finally by surgery and pathology were analyzed in 5 cases admitted from Dec.1992 to July 1999. Results:The 5 cases of ventricular intramural tumor in this series included spongiform tumor,lipoma,infiltrative lipoma,fibroma of left ventricle and bioventricular intramural tumor in 1 case each.They all had paroxysmal ventricular tachycardia (VT) as first clinical manifestation,with ventricular tachycardia rate from 160 to 200 beats per minute.ECGs all showed mimicking myocardial infarction changes including deep T wave inversion in 5 cases, ST segment evelation in 2 cases,and abnormal Q wave in 2 cases.However,they all had no history of myocardial infarction.The location of intramural tumor in those 5 cases were all agreement with the places reflected on ECG regarding both the site of 'infarction'as well as origin of VT.The VT origin in 1 case was confirmed by intracardial electrophysiologic testing. Conclusions:①For the patients with VT as first clinical manifestation,with ECG mimicking myocardial infarction changes,and without history of myocardial infarction,an underlying ventricular intramural tumor should be highly suspected and considered.Appropriate cardiac image studies are needed for determining the diagnosis.②The places reflected myocardial infarction and origin of VT on ECG have important value in locating the ventricular intramural tumor.