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中华诊断学电子杂志

中华诊断学电子杂志 ›› 2022, Vol. 10 ›› Issue (04) : 243 -247. doi: 10.3877/cma.j.issn.2095-655X.2022.04.006

心血管疾病诊治

非典型心尖肥厚型心肌病的诊断学特征
代雪宁1, 孟润祺1, 左汉恒2, 宋秉春2, 张金国2,†()   
  1. 1. 272013　济宁医学院临床医学院
    2. 272029　济宁医学院附属医院心内科
  • 收稿日期:2022-06-18 出版日期:2022-11-25
  • 通信作者: 张金国
  • 基金资助:
    山东省2018年专业学位研究生教学案例库项目(SDYAL18100)

The diagnostic features of atypical apical hypertrophic cardiomyopathy

Xuening Dai1, Runqi Meng1, Hanheng Zuo2, Bingchun Song2, Jinguo Zhang2,†()   

  1. 1. College of Clinical Medicine, Jining Medical University, Jining 272013, China
    2. Department of Cardiology, the Affiliated Hospital of Jining Medical University, Jining 272029, China
  • Received:2022-06-18 Published:2022-11-25
  • Corresponding author: Jinguo Zhang
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代雪宁, 孟润祺, 左汉恒, 宋秉春, 张金国. 非典型心尖肥厚型心肌病的诊断学特征[J]. 中华诊断学电子杂志, 2022, 10(04): 243-247.

Xuening Dai, Runqi Meng, Hanheng Zuo, Bingchun Song, Jinguo Zhang. The diagnostic features of atypical apical hypertrophic cardiomyopathy[J]. Chinese Journal of Diagnostics(Electronic Edition), 2022, 10(04): 243-247.

目的

探讨非典型心尖肥厚型心肌病的诊断学特征。

方法

回顾性分析济宁医学院附属医院心内科收治的1例非典型心尖肥厚型心肌病患者2018年6月至2022年4月的临床资料，总结非典型心尖肥厚型心肌病的诊断学特征，并复习相关文献。

结果

患者既往多次发病时临床表现均为胸闷、胸痛。心电图提示V2-V6导联T波倒置，最大振幅0.8 mV。超声心动图及冠状动脉造影检查结果未见明显异常。心脏功能磁共振成像示左心室心尖心肌相对增厚，左心室舒张末期基底段下壁厚度为6.85 mm，心尖段下壁厚度为12.17 mm，心尖段下壁与其后段下壁厚度之比为1.78，舒张期左心室呈"黑桃尖"样改变，伴左心室运动异常。患者诊断为心尖肥厚型心肌病，给予琥珀酸美托洛尔、盐酸曲美他嗪对症治疗，随访3个月，无特殊不适。

结论

非典型心尖肥厚型心肌病患者，特别是早期无症状或无特异性临床表现时易被漏诊，需综合心电图、影像学等手段方能明确诊断，尤其是完善心脏磁共振成像检查将有助于减少误诊率。

关键词: 心尖肥厚型心肌病，非典型, 心绞痛，不稳定型, 心脏功能磁共振成像
Objective

To investigate the diagnostic features of atypical apical hypertrophic cardiomyopathy (AHCM).

Methods

The clinical data of one patient with atypical AHCM presented at the Department of Cardiology of the Affiliated Hospital of Jining Medical University from June 2018 to April 2022 were retrospectively analyzed. The diagnostic features of atypical AHCM were summarized and relevant literates were reviewed.

Results

The patient had previously experienced numerous instances of chest pain and tightness. In V2-V6 of the ECG, there was T-wave inversion, and the maximum amplitude was 0.8 mV. The results of echocardiography and coronary angiography were normal. According to cardiac function magnetic resonance imaging, the inferior wall (basal segment) was 6.85 mm thick at left ventricular end diastole and the inferior wall (apical segment) was 12.17 mm thick, and the ratio of the thickness in the inferior wall (apical segment) to the inferior wall (basal segment) was 1.78. The left ventricular apical myocardium was also relatively thickened. It displayed a " ace-of-spade" left ventricular silhouette with irregular left ventricular motion. Metoprolol succinate and trimetazidine hydrochloride were administered as symptomatic therapy for the patient′s AHCM. Three months of patient monitoring revealed no discomfort.

Conclusions

Patients with atypical AHCM, especially when early lesions are asymptomatic or have non-specific clinical manifestations, are easily missed. And it usually requires the combination of electrocardiogram and imaging examination to make an accurate diagnosis, especially a complete cardiac magnetic resonance imaging will help reduce the misdiagnosis rate.

Key words: Apical hypertrophic cardiomyopathy, atypical, Angina, unstable, Cardiac function magnetic resonance imaging
图1 非典型心尖肥厚型心肌病患者心电图图像注：a图为2018年6月心电图图像，示窦性心动过缓，心律不齐，ST-T改变；b图为2021年8月心电图图像，示窦性心律，QT/QTc：414/418 ms，RV5+SV1＝3.34 mV，V2-V6导联T波倒置，最大振幅0.8 mV；c图为2022年4月心电图图像，示窦性心律，QT/QTc：382/385 ms，RV5+SV1＝3.34 mV，V4-V6导联T波倒置，最大振幅0.4 mV
图2 非典型心尖肥厚型心肌病患者2022年4月心脏磁共振成像图像注：a图示左心室心尖心肌肥厚；b图示"黑桃尖"样改变；c图示左心室舒张末期心尖段下壁厚度为12.17 mm；d图示左心室舒张末期基底段下壁厚度为6.85 mm(箭头所示)
图3 非典型心尖肥厚型心肌病患者疾病进展时间轴注：ECG为心电图；AHCM为心尖肥厚型心肌病；LM为左主干；LAD为左前降支；LCX为左回旋支；RCA为右冠状动脉；UCG为超声心动图；CMR为心脏磁共振成像
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