心尖肥厚型心肌病心电图1例

患者男性 ,４０岁。因胸闷１年 ,加重３天入院。曾诊断为冠心病。体检 :ＢＰ１１０／７０ｍｍＨｇ,心界不大 ,心尖搏动强有力 ,心率６８次／ｍｉｎ ,心律齐 ,心尖区可闻及Ⅱ级收缩期杂音及第３心音。肝脾无肿大。Ｘ线胸片及血清心肌酶检查正常。心电图 (图１)示 :窦性心律 ,心率６０次／ｍｉｎ ,Ｐ＿Ｒ间期０．１４ｓ ,ＱＲＳ时间０．０８ｓ ,ＱＲＳ波群在Ⅱ导联呈Ｒ型 ,Ｖ５ 导联呈ＲＳ型 ,Ｖ６ 导联呈Ｒｓ型 ,没有Ｑ波 ,而Ｖ１、２ 导联呈ＱＳ型 ,没有ｒ波 ,Ｖ４～６ＳＴ段压低＞０．０５ｍＶ ,Ｔ波Ｉ、ａＶＬ浅倒 ,Ｖ３～６ 深尖倒置 ,Ｖ…     

50例心尖肥厚型心肌病患者心电图特点分析

对2002～2006年确诊的50例心尖肥厚型心肌病(AHCM)患者的心电图进行回顾性分析,结果发现50例患者均有左胸导联T波倒置及ST段压低,呈典型的Tv4＞Tv5＞Tv3者30例,左胸导联R波电压增高44例,Rv4＞Rv5＞Rv6者35例.认为胸前导联T波倒置伴R波振幅增高为AHCM的特征性心电图表现,临床应注意与冠心病、心肌梗死等鉴别.     

心尖肥厚型心肌病3例心电图分析

心尖肥厚型心肌病是原发性肥厚型心肌病的一个亚型 ,临床上较少见。我科自 1998年以来收治本病 4例 ,现择其中3例分析心电图表现如下。例 1:患者男 ,46岁 ,因胸闷 3年 ,加重 3天入院。曾诊断冠心病。心电图 :窦性心律 ,心率 68次 / min,P- R间期 0 .16s,QRS时间 0 .0 8s,V1 导联 r S型 ,V5导联 Rs型 ,没有 q波 ,RV4高 2 .5 m V,RV5+ SV1 =3 .7m V。 I、a VL、V4- 6 ST段压低0 .0 5～ 0 .10 m V,T 波 I、a VL、V3- 6 倒置 ,V4倒置最深达0 .7m V,Q - T间期 0 .46s。 X线胸片及血清心肌酶检查正常。心电图诊断 :窦性心律 ,心肌缺…     

5例心尖肥厚型心肌病心电图分析

心尖肥厚型心肌病 (ＡＨＣＭ)属原发性心肌病的 1种特殊类型 ,因其特殊的心电图特征 ,日益引起人们关注。本文报告 5例于后。男 4例 ,女 1例 ,年龄 2 1～ 47(平均3 4 5 )岁 ,病程 6月～ 6年 ,临床症状各异 ,病程短者可无明显症状 ,仅在健康查体时发现 ( 2例 )。随病程延长可有活动后胸闷、气短等 ,无高血压及心绞痛病史。均经二维超声心动图 (ＵＣＧ)确诊。ＵＣＧ显示 :心尖部局限性心肌肥厚 19～3 0ｍｍ ,无左室流出道狭窄 ,无瓣膜病变 ,房室各腔大小正常。 2例给予冠脉造影显示冠脉无狭窄。心电图表现为　①左胸导联Ｒ波振幅增高 :5例左胸…     

体表心电图对心尖肥厚型心肌病的诊断价值

心尖肥厚型心肌病是主要累及心尖部的变异型心肌病,多见于日本,故又称“日本心肌病”。而在我国较少见,约占肥厚型心肌病2％～5％左右,因其有特殊的心电图特征,近年来日益引起有关人士的重视。现分析所见7例心尖肥厚型心肌病的心电图特征,以提高心电图对此病的诊断。     

心尖肥厚型心肌病心电图的典型表现

患者女性,42岁。于1998年体查时,临床依据心电图提示“慢性冠状动脉供血不足”而诊断为冠心病,并对症治疗。此间患者无明显的不适感觉,既往亦无高血压病史。从2001年12月开始患者自觉胸闷、心悸、气短、尤其在活动或劳累后明显。因胸闷、气短加重1W入院。体格检查：血压130／80mmHg,神志清,口唇无紫绀,无颈静脉怒张,心率72     

肥厚型心肌病患者的心电图改变

肥厚型心肌病的病理改变主要以心室肌肥厚为特征,并且还会影响到左心室以及室间隔,很多是非对称性左室肥厚。该病的心电图异常率和患者有无症状、室间隔肥厚程度密切相关。而ST-T异常是肥厚型心肌病较常见的心电图表现之一。本文主要对肥厚型心肌病,尤其是心尖肥厚型心肌病的心电图改变现象进行综述。     

心尖肥厚型心肌病四例心电图误诊分析

心尖肥厚型心肌病在心电图上呈胸前导联巨大Ｔ波倒置,高ＱＲＳ波,同时伴ＳＴ段下降,酷似心肌缺血或心内膜下心肌梗塞的心电图改变［１］。加之患者刚好处于冠心病的发病年龄段,临床上往往被误诊断为“冠状动脉硬化性心脏病”甚至“前壁心内膜下心肌梗塞”［２］。我院...     

心尖肥厚型心肌病的心电图对比观察

目的　观察心尖肥厚型心肌病 (AHCM )与其他类型的肥厚型心肌病 (HCM )的心电图改变。方法　对 87例HCM(B组 )者行彩色多普勒超声心动图 (UCG)及心电图检测 ,对比 1 6例AHCM组 (A组 )与 71例HCM组 (B组 )的心电图ST段压低、T波倒置、传导阻滞、病理性Q波、左室高电压、WPW的发生率。结果　A组与B组的病理性Q波、巨大倒置T波的发生率存在显著性差异 (P <0 0 5 )。结论　A、B组两组之间虽然心电图及其它方面存在许多共性 ,但病理性Q波以及巨大倒置T波的存在与否 ,对两种HCM的心电图改变有鉴别诊断价值。     

心尖肥厚型心肌病的诊断分析

心尖肥厚型心肌病(AHCM)是肥厚型心肌病的一种亚型.病变主要局限于左室乳头肌水平以下的心尖部.其发病率低,临床表现缺乏特异性.本文对21例心尖肥厚型心肌病的患者进行临床分析.现报告于下.     

Evolution of the electrocardiographic changes in patients with hypertrophic cardiomyopathy.

In 75 patients with hypertrophic cardiomopathy (HCM) followed for a mean period of 5.5 years (range 2-20 years), evolution of the electrocardiographic (EKG) changes was assessed. Progression of EKG abnormalities occurred in 35 patients (47%). It was manifested by an increase in precordial QRS voltage in 33 patients, development of new P-wave mitral in 11 patients, and development or disappearance of pathologic Q waves in 14 patients. With follow-up times greater than 5 years, 5-8 years, and greater than 8 years, EKG progression was present in 27, 41, and 80% of patients, respectively. Age less than 30 years at the beginning of study and left ventricular outflow obstruction predisposed to EKG progression within 5-8 years. Patients with progressive EKG changes were more prone to experience clinical deterioration than those without EKG progression (63 vs. 15%, p less than 0.001). With chronic verapamil administration, progression of EKG abnormalities occurred insignificantly less often than with propranolol treatment (35 vs. 64%, p = 0.20). It is concluded that with long-term follow-up, HCM tends to progress in a significant proportion of adult patients.     

Hypertrophic cardiomyopathy: a case of symptomatic Japanese type apical hypertrophic cardiomyopathy

A 61-year-old male patient was hospitalized due to the exertional angina pectoris. A diagnosis of apical hypertrophic cardiomyopathy was made by ECG (electrocardiography), echocardiographic, and coronary angiographic findings. This case was reported and related literature was reviewed because of its similarity to Japanese type apical hypertrophic cardiomyopathy (AHCMP) cases rarely seen outside Asia.     

Coronary artery-left ventricular fistula with apical hypertrophic cardiomyopathy

We describe two patients with coronary artery-left ventricularfistulae in association with apical hypertrophic cardiomyopathywho presented with chest pain.     

Contrast-enhanced echocardiography for the diagnosis of apical hypertrophic cardiomyopathy

The echocardiographic diagnosis of apical hypertrophic cardiomyopathy can be difficult in patients with poor acoustic windows. However, contrast-enhanced echocardiography can provide better images in these patients and lead to the correct diagnosis. We present a patient with apical hypertrophic cardiomyopathy who was diagnosed using contrast-enhanced echocardiography. The use of contrast-enhanced echocardiography for the diagnosis of apical hypertrophic cardiomyopathy in patients with poor acoustic windows is discussed and the experience in the literature reviewed.     

Long-term evaluation of patients with apical hypertrophic cardiomyopathy: Correlation between quantitative echocardiographic assessment of apical hypertrophy and clinical-electrocardiographic findings

Apical hypertrophic cardiomyopathy (AHCM) is characterized byprimary hypertrophy localized exclusively in the apex of theleft ventricle. Previous studies have indicated that AHCM resultsin a unique combination of cross-sectional echocardiographic(CSE) and ECG findings (‘giant’ Twave inversionand high R wave voltage in the precordial leads). The aims ofthis study were: (1) to assess the degree of AHCM in a quantitativefashion (2) to evaluate the possible relationship between apicalhypertrophy, quantitatively determined, and ECG findings inpatients with AHCM (3) to verify the changes in echocardiographicand ECG parameters over time (4) to define the relationshipbetween the severity of AHCM and the clinical course of suchpatients. Eleven selected patients with AHCM were studied for an average6 year follow-up period; there were seven men and four women(age from 18 to 62 years, mean 49). Apical hypertrophy was assessedquantitatively by determining the muscle cross-sectional areain the apical region, which was considered an index of myocardialmass. From the end-diastolic apical four chamber view, endocardialand epicardial contours were digitized in order to obtain thetotal muscle cross-sectional area of the left ventricle. Thewalls of the left ventricle were then divided into three regions(basal, intermediate, apical). The final value of each cross-sectionalmuscle area was obtained from the mean measurements of fourindependent and blinded observers. In AHCM the apical musclecross-sectional area (AMA) ranged from 10.3 to 17.9 cm², mean13.2 ±2.6 cm². The comparison between CSE and ECG findingsshowed that patients with giant negative T wave inversions (Twave >10 mm) and high R wave voltages (R wave >25 mm)had a more severe degree of apical hypertrophy. However, therewas incomplete agreement between CSE and ECG findings. During follow-up, negative T wave amplitude increased from 8.5±3.4 to 11.9 ±3.6 mm (mean 4.2 ±2.7) in10 patients (P>0.01) and there was a mild increase of precordialR wave (from 28.0 ±5.9 to 29.3 ± 5.2 mm, mean1.5 ± 1.6) (P–ns). The AMA change over time, from13.2 ± 26 to 13.8 ± 2.3 was not significant. Allpatients were alive at the most recent evaluation, and witlioutsignificant symptomatic deterioration. This study demonstrates a wide spectrum in the degree of severityof apical hypertrophy among patients with AHCM. Furthermore,ECG findings are not uniform and are not significantly relatedto the severity of the hypertrophy itself Therefore, AHCM shouldbe considered as a part of the morphological spectrum of hypertrophiccardiomyopathy rather than a separate entity with univocal CSEand ECG findings. Follow-up data indicate that despite ECG results worsening overtime, a significant progression in apical left ventricular wallthickness does not occur. Changes in negative T wave amplitudeare not related to symptoms and are not predictive of the functionalseverity of AHCM. Finally, the clinical outcome of patientswith AHCM seems not be dependent on the entity of apical hypertrophy.     

肥厚型心肌病患者心电图分析

目的探讨肥厚型心肌病住院患者的心电图特点。方法对1994年5月～2005年7月北京大学人民医院和北京世纪坛医院收治的经超声心动图诊断为肥厚型心肌病的住院患者76例,分析其心电图特点。结果按肥厚的部位分为单纯室间隔肥厚或室间隔肥厚为主组(46例)、单纯心尖肥厚组(14例)、单纯游离壁肥厚组(6例)和弥漫性肥厚组(10例)。间隔肥厚为主组患者中,23例(50.0%)存在病理性Q波,其中间隔厚度超过2.0cm者10例(42.5%);而在另23例无病理性Q波患者,间隔厚度超过2.0cm者仅5例(21.7%)。心尖肥厚组和单纯游离壁肥厚组均仅1例心电图存在病理性Q波。QRS波群宽度在各组无显著性差异(p>0.05)。76例患者中,心电图符合左室肥厚(SV1 RV5≥4.0mV)诊断标准的23例(30.3%),符合RV4>RV5>RV6(或RV3>RV4>RV5)者34例(44.7%),ST-T改变共71例(93.4%),ST段下移超过0.1mV者53例(69.7%),T波深倒置振幅超过0.5mV者30例(39.5%)。T波深倒置在心尖肥厚组多于间隔肥厚组(P=0.02),但T波倒置深度与心尖肥厚程度无明显相关(p=0.40)。间隔肥厚为主组中梗阻型和非梗阻型各项心电图指标无显著性差异(p>0.05)。结论病理性Q波多出现在室间隔肥厚为主型患者,T波深倒置在心尖肥厚组多于间隔肥厚组,但T波倒置深度与心尖肥厚程度无明显相关。     

Echocardiographic diagnosis of apical hypertrophic cardiomyopathy with optison contrast

We describe a case of obstructive apical hypertrophic cardiomyopathy in a 61-year-old Caucasian female with a history of chest pain syndrome. The patient was referred to the echo lab by her nuclear cardiologist, who was impressed by her abnormal stress nuclear perfusion scan that showed marked increased uptake of radioisotope at the left ventricular (LV) apex. The patient had deep negative T waves on her electrocardiogram similar to those originally described in the Japanese population. Transthoracic echocardiography with native harmonic imaging was suboptimal for visualizing LV segments. Therefore, 0.5 cc of Optison contrast was given intravenously, with repeat transthoracic imaging confirming the diagnosis. The patient and her family were referred for additional genetic testing and cardiovascular workup.     

Magnetic resonance imaging for assessment of apical hypertrophy in hypertrophic cardiomyopathy

The purpose of the study was to evaluate the value of magnetic resonance imaging as compared with two-dimensional echocardiography for a reliable assessment of the degree and distribution of apical hypertrophy in hypertrophic cardiomyopathy (HCM). The study includes 10 HCM patients (8 males and 2 females, mean age: 42±7 years). Two-dimensional echocardiography was not definitive in assessing the abnormal thickening of the apical myocardium in two patients. Two other patients had inadequate echocardiographic visualization of the lower left ventricle due to technical reasons. At magnetic resonance imaging, 3 patients showed localized hypertrophy at the left ventricular apex only. Three other patients had evidence of hypertrophy at the apex as well as at the left ventricular free wall. In four patients, the hypertrophy was detected at either the apex or the lower interventricular septum. It is concluded that magnetic resonance imaging might provide an accurate assessment of myocardial hypertrophy in HCM patients. This technique appears to be of major value in those with wall thickening localized to (or predominant in) the apical portion of the ventricle.