心尖肥厚型心肌病的临床诊断(附13例临床报告)

目的：探讨心尖肥厚型心肌病的心电及影像学检查的特点及临床诊断价值。方法：对13例心尖肥厚型心肌病的心电图、超声心动图、放射核素心肌断层显像、冠状动脉造影及左室造影、磁共振成像等检查方法进行分析总结。结果：心电图的典型改变是胸前导联巨大倒置的T波伴ST段下降和QRS波群高血压,以V4导联最为显。超声心动图示心尖部肥厚,心尖部心室腔狭小甚至闭塞。磁共振成像清晰显示心尖部心肌肥厚。心室造影左心室舒张末期呈“黑桃”样改变,但部分呈“非黑桃”样改变。结论：心电图胸前导联巨大倒置T波TV4＞TV5伴QRS波群高血压RV4＞RV5是诊断AHCM的重要线索。超声心动图是诊断AHCM的重要手段。磁共振成像对确诊该病最有价值。心血管造影及放射性核素心肌显像是AHCM的鉴别诊断手段但不是必备检查。

The clinical diagnosis of apical hypertrophic cardiomyopathy: A report with 13 cases

Objectives To study the characterization of the electrocaridial and imaging examinations of apical hypertropinc cardiomyopathy (AHCM) and to evaluate the value on clinical diagnosis. Methods Of the electrocardiogram, echocardiogra-phy, radionuclide 99m Tc-MIBI myocardial scanning, coronary angiography and left ventriculography, magnetic resonance imaging and other special examinations of 13 cases with AHCM were analyzied. Results The typical EGG showed giant negtive T waves and ingh QRS voltage in precordial leads particularly in lead ?. The echocardiograpinc feature was apical hypertrophy, a small apical intraventricular cavity even obliteration of the apex. Magnetic resonance imaging indicated apical hypertrophy clearly. Left ventriculography showed the characteristic spade-like configuration on the end-diastolic, but some cases had " nonspade-like" changes. Conclusions The characters of giant negtive T waves of Tv4 , TVS and ingh QRS voltage of Rv4 , RVS in EGG are the important clue on the clinical diagnosis of AHCM. Echocardiography is the major technique in the evaluation of AHCM. Magnetic resonance imaging is the most valueable technique on diagnosis. Left ventriculography and radionuclide myocardial scanning are the techniques of differential diagnosis but not the essential examinations.