Hess O M, Schneider J, Gloor H O, Lütolf U M, Keiser G
Z Kardiol. 1977 Feb;66(2):95-8.
A 43-year-old woman with anginal pain and the electrocardiographic signs of an old anterior infarction presented the clinical, hemodynamic and angiographic findings of congestive cardiomyopathy. Left ventricular (LV) end-diastolic volume was sizably increased, there was generalized hypokinetic wall motion and LV ejection fraction was reduced to 40 percent. The subsequent clinical course was characterized by progressive congestive heart failure and the patient died 4 years after the first appearance of symptoms. Autopsy revealed marked dilatation of all heart chambers and severe hypertrophy of the LV anterior wall. The LV posterior wall and the septum were less markedly hypertrophied. Light and electron microscopy showed the typical findings of hypertrophic cardiomyopathy in the anterior part of the LV wall whereas the septum and the LV posterior wall presented unspecific histological alterations. In conclusions, this case demonstrates that a clinically typical congestive cardiomyopathy may be associated with a localized area characteristic for hypertrophic cardiomyopathy. Thus it is a postulated that the described patient represents an intermediary form of primary myocardial disease.
一名43岁女性，有胸痛症状且心电图显示有陈旧性前壁梗死迹象，其临床表现、血流动力学及血管造影结果均提示为充血性心肌病。左心室舒张末期容积显著增加，存在普遍性室壁运动减弱，左心室射血分数降至40%。随后的临床病程以进行性充血性心力衰竭为特征，患者在症状首次出现4年后死亡。尸检显示所有心腔均有明显扩张，左心室前壁严重肥厚。左心室后壁和室间隔肥厚程度较轻。光镜和电镜检查显示左心室壁前部有肥厚型心肌病的典型表现，而室间隔和左心室后壁呈现非特异性组织学改变。总之，该病例表明临床上典型的充血性心肌病可能与肥厚型心肌病的局部特征区域相关。因此推测所描述的患者代表原发性心肌病的一种中间形式。
