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A 47-year-old man with apical hypertrophic cardiomyopathy and an apical left ventricular aneurysm with palpitation as the initial manifestation is described. There was no intraventricular pressure gradient. The aneurysm is suggested to be a part of the myocardial disease or to be caused by myocardial bridging of the left anterior descending coronary artery demonstrated by angiography. The 24-hour ambulatory ECG recording showed only isolated ventricular ectopic beats and the clinical course has been favorable during 20 months without therapy. 相似文献
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心尖肥厚型心肌病(AHCM)是肥厚型心肌病(HCM)的一种较为罕见的表型,其肥厚部位主要限于左室心尖部,主要以V4~V6巨大倒置T波及左室造影呈“锹状”改变为特征。本文对该病发病情况、病因、病理、病理生理及诊治情况的最新进展作一综述。 相似文献
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Seventy-eight consecutive survivors of a first acute anteriorQ wave myocardial infarction (AMI) underwent two-dimensionalechocardiography (2D echo), colour Doppler echo and radionuclideangiography (RNA) for the diagnosis of left ventricular (LV)anteroapical aneurysm, in order to study the relationship ofthis complication to precordial ST segment elevation in thesepatients. The ST elevation (mm) in lead V2, the maximum ST elevationin V1-V6 and the sum of ST elevation in V1 to V6 were calculated.LV aneurysm was present in 19 patients by 2D echo, of whom 12had a paradoxical systolic flow pattern (red and outward towardsthe transducer) at the apex. There was no difference between the mean ST elevation in V2or the maximum ST elevation in V1-V6 in patients with and withoutan aneurysm, although the sum of ST elevations in V1 to V6 washigher in the former group (P<0.01). ST elevation of patientswith and without paradoxical systolic flow also did not differsignificantly. Wall motion abnormality (akinesis and dyskinesis)by 2D echo in the anterior wall was seen in 74% of patientswith and 36% of patients without an aneurysm (P<0.005), andin the septal region in 63% and 47% of respective patients (P-NS).There was no difference between the magnitude of ST elevationin subgroups of patients with ejection fraction (EF) 30% to40%, but the mean EF of patients with (23 ± 2.1%) andwithout a LV aneurysm (34 ± 1.3%) differed (P<0.001). It is concluded that precordial ST segment elevation does notclearly and in the diagnosis of an anteroapical LV aneurysm.It is related to akinesis and dyskinesis in anterior and septalregions inherent in patients with AMI and does not indicateimpaired LV function. 相似文献
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A 70-year old lady with prior myectomy for hypertrophic obstructive cardiomyopathy presented with sustained ventricular tachycardia. She was found to have a large left ventricular (LV) apical aneurysm. Surgical intervention was not advised, due to the risk of creating a small LV cavity after surgery and ICD was not advised based on the risk of injuring a very thin walled aneurysm. The patient's arrhythmia settled on medical therapy, but unfortunately she suffered an unwitnessed death three months later.This case represents a rare complication to a rare disease with limited management options. In such patients evidence based medicine is of little help, if any. 相似文献
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Rosario Parisi Francesca Mirabella Gioel Gabrio Secco Rossella Fattori 《World journal of cardiology》2014,6(9):916-923
Apical hypertrophic cardiomyopathy(AHCM) is a relatively rare morphologic variant of HCM in which the hypertrophy of myocardium is localized to the left ventricular apex. Symptoms of AHCM might vary from none to others mimic coronary artery disease including acute coronary syndrome, thus resulting in inappropriate hospitalization. Transthoracic echocardiography is the firstline imaging technique for the diagnosis of hypertrophic cardiomyopathies. However, when the hypertrophy of the myocardium is localized in the ventricular apex might results in missed diagnosis. Aim of this paper is to review the different imaging techniques used for the diagnosis of AHCM and their role in the detection and comprehension of this uncommon disease. 相似文献
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We describe an unusual case of coronary artery-left ventricular fistulae associated with apical hypertrophic cardiomyopathy in a 63-year-old man who had a 2-year history of angina pectoris without significant coronary atherosclerosis. It is important to recognize this anomaly as it may be the source of angina in patients without angiographic evidence of major atherosclerotic coronary artery disease. 相似文献
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We describe a patient with asymptomatic apical hypertrophic cardiomyopathy(AHCM)who later developed cardiac arrhythmias,and briefly discuss the diagnostic modalities,differential diagnosis and treatment option for this condition.AHCM is a rare form of hypertrophic cardiomyopathy which classically involves the apex of the left ventricle.AHCM can be an incidental finding,or patients may present with chest pain,palpitations,dyspnea,syncope,atrial fibrillation,myocardial infarction,embolic events,ventricular fibrillation and congestive heart failure.AHCM is frequently sporadic,but autosomal dominant inheritance has been reported in few families.The most frequent and classic electrocardiogram findings are giant negative T-waves in the precordial leads which are found in the majority of the patients followed by left ventricular(LV)hypertrophy.A transthoracic echocardiogram is the initial diagnostic tool in the evaluation of ACHM and shows hypertrophy of the LV apex.AHCM may mimic other conditions such as LV apical cardiac tumors,LV apical thrombus,isolated ventricular non-compaction,endomyocardial fibrosis and coronary artery disease.Other modalities,including left ventriculography,multislice spiral computed tomography,and cardiac magnetic resonance imagings are also valuable tools and are frequently used to differentiate AHCH from other conditions.Medications used to treat symptomatic patients with AHCM include verapamil,beta-blockers and antiarrhythmic agents such as amiodarone and procainamide.An implantable cardioverter defibrillator is recommended for high risk patients. 相似文献
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Daniel Z. Fisher Thomas G. DiSalvo G. William Dec Roman W. DeSanctis 《Clinical cardiology》1993,16(3):253-256
Left ventricular wall motion abnormalities, aneurysm formation, and progression to global hypokinesis have been described in patients with myocarditis and in patients with hypertrophic cardiomyopathy. We document a case of reversible aneurysm formation, cardiogenic shock, and complete recovery in a patient with myocarditis and hypertrophic cardiomyopathy. Pathophysiologic mechanisms of myocardial injury and recovery are discussed. 相似文献
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心尖肥厚型心肌病的心电图特征 总被引:2,自引:0,他引:2
分析10例心尖肥厚型心肌病的心电图。9例V3-V6R波异常高大,尤以V3-V5,为甚,伴T波倒置。内8例呈巨大倒置T波。6例24小时动态心电图2例活动平板心电图运动试验心率增快时T波倒置无变化。 相似文献
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ST段持续抬高与室壁瘤、室壁运动异常与左室大小的关系 总被引:4,自引:0,他引:4
目的 探讨Q波急性前壁心肌梗死患者心电图胸前导联ST段持续抬高与室壁瘤、室壁运动异常和左室大小的关系。方法 连续首次发病的 4 2例急性前壁心肌梗死患者 ,发病 2周时行 12导联心电图和超声心动图检查 ,分别测量心电图上胸前导联ST段抬高的程度 ,左室心内膜面积指数 (ESAi)和室壁运动异常区心内膜面积 (AWMa)和室壁运动异常得分。结果 在V2导联、抬高最大的导联上 ,室壁瘤和非室壁瘤组ST段抬高程度 ,差异无显著性 (p >0 0 5 )。V1至V6导联ST段抬高之总和室壁瘤组大于非室壁瘤组 (P <0 0 5 )。室壁瘤组的室壁运动积分明显高于非室壁瘤组 (P <0 0 1) ,但AWMa和ESAi,两组均无显著差别 (P >0 0 5 )。V2导联、抬高最大的导联和V1至V6导联ST段抬高之总和 ,室壁运动异常积分≥ 8分组显著高于室壁运动异常积分 <8分组 (P均 <0 0 1)。但入院时ESAi增大组和正常组之间无显著差别 (P >0 0 5 )。结论 梗死后 2周 ,心电图胸前导联持续抬高与左室前壁、心尖部和室间隔的运动异常程度有关 ,它并不能帮助明确诊断室壁瘤存在 ,也与左室大小无关 相似文献
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Sustained ventricular tachycardia as a first manifestation of hypertrophic cardiomyopathy with mid‐ventricular obstruction and apical aneurysm in an elderly female patient
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Polychronis Dilaveris MD Constantina Aggeli MD Andreas Synetos MD Ioannis Skiadas MD Christos‐Konstantinos Antoniou MD Eleftherios Tsiamis MD Konstantinos Gatzoulis MD Ioannis Kallikazaros MD Dimitrios Tousoulis MD 《Annals of noninvasive electrocardiology》2017,22(3)
Sustained ventricular tachycardia complicating left ventricular apical aneurysms has been reported previously solely in middle‐aged patients with hypertrophic cardiomyopathy and mid‐cavity obstruction. We report a case of an elderly female patient who presented with incessant ventricular tachycardia as the first clinical manifestation of hypertrophic cardiomyopathy with mid‐ventricular obstruction and apical aneurysm. 相似文献
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János Tomcsányi Béla Bózsik MD Balázs Sármáns MD András Zsoldos MD 《Journal of electrocardiology》2009,42(2):103
Discriminating among the various coronary obstruction patterns influences early management decisions. One of the most important tasks is the identification of ST-elevation myocardial infarction caused by left main occlusion. We present a case of single-lead ST-segment elevation in aVR caused by acute left main coronary artery occlusion. 相似文献
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Kenton L. Anderson Neel A. Shah Moises Gallegos I-Hui Chiang 《Heart & lung : the journal of critical care》2018,47(4):363-365
Background
A 71-year-old non-smoking female with a history of diabetes, hypertension, hyperlipidemia and end-stage renal disease presented to the emergency department for right leg pain due to an ankle fracture.Case
The patient's initial electrocardiogram (ECG) revealed ST segment elevations in the anterior leads. She denied any chest pain, shortness of breath, fatigue, lightheadedness, palpitations, nausea or diaphoresis. Her initial laboratory Troponin I resulted 35.9 ng/mL. Coronary catheterization demonstrated 99% occlusion of the left anterior descending (LAD) coronary artery. The patient had 2 drug eluting stents placed in the LAD with 10% residual stenosis.Conclusion
Although witnessing an ongoing asymptomatic ST elevation myocardial infarction (STEMI) is rare, this case highlights the importance of early revascularization when the ECG demonstrates a STEMI, even in the absence of symptoms for patients at risk for silent myocardial infarctions. 相似文献18.
Patients with hypertrophic cardiomyopathy and additional diastolicflow abnormalities are relatively rare. This report describesa case of apical ventricular hypertrophy with complete systolicobstruction and holodiastolic intraventricular pressure gradient. 相似文献
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We describe two patients with coronary artery-left ventricularfistulae in association with apical hypertrophic cardiomyopathywho presented with chest pain. 相似文献
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目的探讨彩色多普勒(CDFI)与其他检查方法对心尖肥厚型心肌病(AHCM)的诊断价值。方法对31例AHCM患者的CDFI、磁共振检查(MRI、冠脉造影及左心室造影(CAG+LVG)、心电图(EGG)特点进行分析。结果31例均经CDFI检查,28例证实有心尖部心肌肥厚(厚度〉15mm),心尖最大室壁厚度/基底部最大室壁厚度≥1.3。9例进行了LVG,其中有4例显示左室舒张期末心尖部心肌肥厚,左心室舒张末期呈“黑桃”(spade—like)样改变。4例行了MRI检查,均可见心尖部不对称性肥厚。全部患者均合并有ECG异常改变(100%)。31例中有1例合并有右室心尖肥厚。结论CDFI为AHCM最理想的检测方法,如结合以上其他检查,则可进一步提高诊断准确性。 相似文献