17例肥厚型心肌病病人心电I图特点分析

目的提高对肥厚型心肌病的诊断识别.方法对1996年～2000年确诊为肥厚型心肌病17例病人的临床资料进行分析.结果全部病人心电图均有T波异常,9例心尖肥厚型心肌病病人表现为I、aVL、V2～6导联T波倒置,V1～3导联R波幅度明显增加,其中2例伴完全右束支传导阻滞者亦有左胸导联T波明显倒置;5例普遍肥厚型心肌病病人表现为T波倒置导联较心尖肥厚型心肌病病人范围小(V3～6导联伴或不伴I、aVL导联轻度倒置),V1～3导联R波幅度增加不如心尖肥厚型心肌病病人明显;2例间隔肥厚梗阻型心肌病病人有V1～3导联ST段抬高,T波直立,V1～3导联R波不增加与前两型不同;1例间隔肥厚型心肌病伴完全右束支传导阻滞者表现为V1导联呈qR形态,与心尖肥厚型心肌病伴完全右束支传导阻滞者的rsR'亦不相同.结论重视临床和心电图变化采取进一步的检查措施可以最大限度的减少该病的误诊.

Electrocardiographic Features and Clinical Manifestations of Hypertrophic Cardiomyopathy

Objective: To improve the identification of hypertrophic cardiomyopathy (HCM)in clinical diagnosis. Methods: Data from 17 patients with HCM from 1996-2000 were analysed. Results: The patients were divided into 3 types according to hypertrophic patterns: 9 with hypertrophy only at the apex (type I ); 5 with universal hypertrophy (type II ); 3 with asymmetric septal hypertrophy (type IE ) - All patients had T-wave abnormalities in electrocardiogram. The number of precordial leads with giant negative T waves (>or=0.5 mV)was greater in type I than in type II(V2-6, I ,aVLvs. V3-6,with/or I , aVL). Two type I patients also showed left precordial negative T waves even in the presence of complete right bundle branch block. Positive T waves in leads V1-3 were found in type III. Pa- tients of type I had taller R waves in leads V1-3 than those of type II , but no R-wave changes were found in type III. Cardiac enzyme levels were basically normal. Coronary angiography revealed muscle-bridge in 7 but no coronary artery disease in 14. Conclusion: Misdiagnosis of HCM can be greathy avoided through careful observation of ECG findings.