老年人肥厚性心肌病

肥厚性心肌病近来在老年人中有逐渐增多趋势。其血型临床表现，形态学特点及主动脉下梗阻的发生原理，均与年轻人有明显区别。而且易与高血压性心脏病混淆。     

老年高血压性肥厚型心肌病并冠心病2例

倒1 男患，70岁，退休工人。因血压高6年，发作性胸痛半年于94年10月6日入院。患于6年前无明显原因的出现头痛、头晕。初未介意，后于坐位时经常晕倒，每次约20秒钟后清醒。在某院就诊，测血压达26／14Kpa，而诊为“高血压病”及“T.i．A”，给予降压药物等治疗后好转，入院半年前，患时常在饱餐及活动时感心前区闷痛，件左肩背部不适。每次持续10～30分钟不等，入院前1天，症状加重，自服消心痛。安定效不佳而来我院就诊入院，无心肌病家族史。查体：P80次／分，BP23／13Kpa，唇不绀，颈静脉无怒张，双肺无啰音。     

1988年肥厚性心肌病

肥厚性心肌病在不同的医学中心,其各型发生率各异。在多伦多总医院左室非对称性肥厚性心肌病占95%、其中室间隔肥厚90%,心室中部肥厚1%,心尖部肥厚3%,后壁或/和侧壁肥厚1%。对称性肥厚性心肌病5%。肥厚的部位和范围:肥厚的部位和范围决定本病临床表现.基部的(主动脉瓣下)室间隔肥厚导致梗阻型肥厚性心肌病、而孤立的心尖部或侧壁的肥厚则不致引起梗阻。     

肥厚性心肌病

问：什么叫肥厚性心肌病？ 答：肥厚性心肌病（HCM）是心肌原发性病变,表现心肌异常肥厚,LV不能舒张,原因不是高血压或主动脉瓣肥厚.心肌肥厚最常累及室间隔（非对称性室间隔肥厚）,并有左室流出道阻塞.     

老年高血压性肥厚性心肌病并房间隔瘤1例

1病历摘要 患者，女，61岁。因“反复胸闷3个月，加重7天”来院就诊。发现高血压2年余，血压最高达160／100mmHg（1mmHg=0．133kPa），平日服药不规律。既往有高脂血症史4年。查体：T37℃，P68次／min，R18次／min，BP144／92mmHg。双肺未闻及干湿性哕音。心浊音界临界扩大，心率68次／min，心律规整，心音正常，各瓣膜区未闻及杂音，周围血管征阴性。实验室检查：肝功能、肾功能、血电解质、血糖、心肌损伤标志物均正常。TC 4．8mmol／L，TG 3．61mmol／L，ECG正常。心脏超声检查示主动脉内径29mm，主肺动脉内径20mm，左房内径38mm，     

老年高血压性肥厚型心肌病

老年高血压性肥厚型心肌病(HHCME)是近年来命名的一种疾病,多见于有高血压史的老年女性。临床特征为重度心肌肥厚,左室腔径缩小、收缩功能超常,舒张功能明显减退。主要并发症是充血性心力衰竭。洋地黄和血管扩张剂治疗无效,β阻滞剂和钙离子拮抗剂治疗可缓解之。     

肥厚性心肌病的研究新进展

肥厚性心肌病 (ＨＣＭ )是一种具有家族性心脏异常倾向、独特的病理生理和临床过程的特发性心肌病。本文目的在于总结、探讨并阐明当前国外对ＨＣＭ的研究进展。一、命名和流行情况ＨＣＭ的名称是杂乱繁多的 ,反映出它的不一致性 ;以往多数研究是基于一组群病人最为显著的临床特点而撰名的 ,目前是否能把ＨＣＭ看作单一的病种或一组征候群尚未定论[1,2 ] 。ＨＣＭ已成为令众多心血管病研究学者所公认的名字 ,而不像许多其它名字如肥厚性梗阻型心肌病特发性肥厚型主动脉瓣下狭窄等 ,容易使人误入左室流出道梗阻并发症的歧途[3] 。ＨＣＭ能确…     

肥厚性心肌病的内科治疗进展

肥厚性心肌病是严重威胁生命的心脏病之一。本文就近年有关内科治疗的进展作一综述，介绍了应用β－受体阻滞剂、钙拮抗剂、双异丙吡胺、胺碘酮、洋地黄与利尿剂等药物以及起搏器治疗的疗效，并对它们的疗效作了评价。     

肥厚性心肌病完全房室传导阻滞1例

１　病例患者,男性,２５岁,于１９９８－１１开始出现劳力后心慌、气短、体力活动受限,曾在当地医院诊断为肥厚性心肌病。１９９９－０５－０５患者出现头晕、腹胀、食欲减退。５月１１日晕厥１次,为明确诊断来我院就诊。心电图提示完全房室传导阻滞,室率２２次／ｍｉｎ（见图１）。心脏超声：左房、左室扩大,室间隔厚度与左室后壁厚度比例为２．７（１８．０／６．９）,流出道未见明显梗阻,符合非梗阻性肥厚性心肌病。入院后静滴异丙肾上腺素,效果不佳,经临时起搏治疗２４ｈ,患者恢复窦律,室率为６０次／ｍｉｎ～８０次／ｍｉ…     

Loperamide Toxicity Revealing Apical Hypertrophic Cardiomyopathy

Loperamide, a μ-opioid receptor agonist, can cause cardiotoxicity by inhibiting the potassium ion channel and slowing cardiomyocyte repolarization. This, in turn, can lead to frequent early afterdepolarizations, the most common mechanism of drug-induced long QT syndrome and torsades de pointes. Apical hypertrophic cardiomyopathy (AHCM) is a nonobstructive hypertrophic cardiomyopathy rarely associated with malignant arrhythmias. We present a case of loperamide-induced malignant ventricular arrhythmia revealing underlying AHCM in a 25-year-old woman with a history of sudden cardiac arrest (SCA) and opioid use.It is important to evaluate for structural heart disease in all patients presenting with SCA, regardless of presumed etiology such as drug-induced cardiotoxicity, to prevent missed opportunities for adequate treatment. Furthermore, the diagnosis of AHCM in SCA warrants further genetic evaluation for variances with a predilection for malignant arrhythmias.     

肥厚型心肌病病因学研究进展

肥厚型心肌病是以心室壁心肌的非对称性肥厚为特征的一种特发性心肌疾病,目前被认为是一种基因突变所导致的常染色体疾病。在人类,在编码与构成肌小节有关的蛋白质的基因中,现在发现至少有11种基因,超过200种不同的基因突变类型与肥厚型心肌病有关。另外,一些与肌小节无关的基因突变也参与了该病的发生。     

Intraventricular Systolic Flow Mapping in Hypertrophic Cardiomyopathy

Ninety-two consecutive patients with hypertrophic cardiomyopathy were studied with pulsed and continuous-wave Doppler and color flow imaging to assess the intraventricular systolic flow profile from apex to base and compare it with that obtained in normals and in patients with aortic stenosis and systemic hypertension. Hypertrophic cardiomyopathy patients had higher intraventricular blood flow velocities (cm/sec) from apex to base compared with normals and aortic stenosis and systemic hypertension patients (apex: 41.5 ± 17.3 vs 24 ± 1.9,26.1 ± 2.9, and 26.4 ± 3.3; papillary muscles: 95.4 ± 66.5 vs 41.9 ± 4.9, 46.2 ± 3.4, and 46.4 ± 5.7; outflow tract: 249.3 ± 176.2 vs 66.9 ± 8.4, 64.1 ± 10.8, and 66 ± 9.5, respectively) (P < 0.001). Eighty-six (93%) hypertrophic cardiomyopathy patients showed an abnormal intraventricular systolic color flow pattern at one or more sites but none of the patients with aortic stenosis or systemic hypertension or normal controls. Of those, 65 (71%) showed one or more variant (mosaic) flow, all of whom had intraventricular gradients, while 75 showed abnormal aliased flow at a site other than the subaortic area. It is concluded that patients with hypertrophic cardiomyopathy often exhibit an abnormal spatial distribution of the intraventricular systolic flow velocity profile compared with normals and patients with secondary forms of ventricular hypertrophy that can readily be recognized with color flow imaging. This could improve the sometimes difficult separation of hypertrophic cardiomyopathy patients from secondary hypertrophy.     

肥厚型心肌病预后评估的研究进展

肥厚型心肌病是最常见的遗传性心脏病,其临床表现及预后极富多样性。该病患者的不良转归主要有:猝死、心力衰竭以及心房颤动所致的栓塞事件等。现就影响肥厚型心肌病预后的因素作一综述。     

Cardiac Sarcoid: A Chameleon Masquerading as Hypertrophic Cardiomyopathy and Dilated Cardiomyopathy in the Same Patient

Sarcoidosis is a multisystem, granulomatous disease of unknown etiology often seen in young adults, with cardiac involvement in more than one‐quarter of sarcoid patients. The clinical presentation of cardiac sarcoid depends upon the location and extent of myocardium involved. Although cardiac sarcoid may produce asymmetrical septal hypertrophy, it is most commonly considered in the differential diagnosis of dilated cardiomyopathy. The hypertrophic stage of cardiac sarcoid is rarely seen. We describe a case of cardiac sarcoid in a young patient wherein a distinctive appearance of the cardiac sarcoid spectrum from “hypertrophic” stage to thinned/scarred stage, masquerading as hypertrophic cardiomyopathy followed by dilated cardiomyopathy, is demonstrated.     

Evolutionary Change Mimicking Apical Hypertrophic Cardiomyopathy in a Patient with Takotsubo Cardiomyopathy

In this report, we introduce a case of thickening of the involved left ventricular apical segment on echocardiography and deep T‐wave inversions in precordial leads on electrocardiography transiently seen in the course of recovery from biventricular takotsubo cardiomyopathy, mimicking apical hypertrophic cardiomyopathy. This result suggests that the echocardiographic finding of transient myocardial edema can be identified by cardiac magnetic resonance imaging in takotsubo cardiomyopathy. Additionally, it persisted a few weeks after full functional recovery. We believe that this case will contribute in part toward clarifying the pathophysiology of takotsubo cardiomyopathy.     

Trileaflet Mitral Valve with Three Papillary Muscles Associated with Hypertrophic Cardiomyopathy: A Novel Case

Congenital mitral valve (MV) malformations are uncommon, except for MV prolapse. Despite their infrequency, most of them are well‐known and defined entities, such as congenital MV stenosis with two papillary muscles, parachute MV, supravalvular mitral ring, hypoplastic MV, isolated cleft in the anterior and/or posterior leaflets, and double‐orifice MV. A trileaflet MV with three separate papillary muscles with concordant atrioventricular and ventricle–arterial connections is exceptionally rare. To the best of the authors' knowledge, it has been reported only once in association with subaortic valvular stenosis. We hereby describe a novel case associated with hypertrophic cardiomyopathy.