非典型心尖肥厚型心肌病的诊断学特征

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V_(2)-V_(6)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。

The diagnostic features of atypical apical hypertrophic cardiomyopathy

ObjectiveTo investigate the diagnostic features of atypical apical hypertrophic cardiomyopathy (AHCM). MethodsThe 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. ResultsThe 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. ConclusionsPatients 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.