Ito Masahiro, Tanabe Yasuhiko, Suzuki Kaoru, Kumakura Makoto, Aizawa Yoshifusa
First Department of Internal Medicine, Niigata University School of Medicine, Japan.
Circ J. 2002 Nov;66(11):1070-2. doi: 10.1253/circj.66.1070.
A 73-year-old heavy drinker was admitted to hospital in a state of shock. He had been suffering from frequent angina at rest, causing him to drink more heavily in an effort to overcome his anginal chest pain. He had been drinking hard each day and had not eaten for 4 weeks. His hemodynamic state on admission showed high-output heart failure. Echocardiography revealed hyperkinesis of the left ventricle and mid-ventricular obstruction with peak intraventricular gradients of 30 mmHg. Although no improvement was seen despite administering the maximal dose in catecholamine therapy, his condition improved rapidly after vitamin B(1) was administered. Cardiac catheterization revealed mid-ventricular obstruction with an apical aneurysm. Coronary artery spasm was induced by injecting acetylcholine in the distal site of the left anterior descending artery, which perfused the area of the apical aneurysm. In the present case, both left ventricular hyperkinesis caused by shoshin beriberi and apical myocardial infarction caused by frequent coronary spasms produced mid-ventricular obstruction with an apical aneurysm.
一名73岁的酗酒者因休克状态入院。他一直患有频繁的静息性心绞痛，这导致他为了克服心绞痛而大量饮酒。他每天酗酒，并且已经4周未进食。入院时他的血流动力学状态显示为高输出量心力衰竭。超声心动图显示左心室运动亢进和心室中部梗阻，心室峰值梯度为30 mmHg。尽管在儿茶酚胺治疗中给予了最大剂量但未见改善，然而在给予维生素B1后他的病情迅速好转。心导管检查显示心室中部梗阻伴有心尖部动脉瘤。通过在灌注心尖部动脉瘤区域的左前降支动脉远端注射乙酰胆碱诱发冠状动脉痉挛。在本病例中，韦尼克脑病引起的左心室运动亢进和频繁冠状动脉痉挛导致的心尖部心肌梗死均产生了伴有心尖部动脉瘤的心室中部梗阻。
