Almeida Sofia, Cotrim Carlos, Brandão Luís, Miranda Rita, Loureiro Maria José, Simões Otília, Lopes Luís, Carrageta Manuel
Serviço de Cardiologia do Hospital Garcia de Orta, Almada, Portugal.
Rev Port Cardiol. 2007 Mar;26(3):257-62.
We describe a 79-year-old male patient with no significant risk factors for coronary heart disease besides age and gender. He was referred for cardiology consultation because of effort dyspnea. Diagnostic exams including laboratory tests, chest X-ray, ECG and resting echocardiogram showed no abnormalities. He underwent exercise stress echocardiography, which revealed reduced exercise tolerance and a dynamic left ventricular outflow tract obstruction with an intraventricular gradient of over 50 mmHg. No segmental wall motion abnormalities were observed. He was treated with the beta-blocker bisoprolol 5 mg qd, with significant clinical improvement. Two years later exercise stress echocardiography was repeated and better functional capacity was apparent, with no intraventricular gradient during peak exercise. The authors discuss the clinical importance of this unsuspected cause of symptoms in the elderly.
我们描述了一位79岁男性患者，除年龄和性别外，无其他明显的冠心病危险因素。他因劳力性呼吸困难转诊至心内科咨询。包括实验室检查、胸部X线、心电图和静息超声心动图在内的诊断检查均未发现异常。他接受了运动负荷超声心动图检查，结果显示运动耐量降低，存在动态左心室流出道梗阻，室内压差超过50 mmHg。未观察到节段性室壁运动异常。给予他比索洛尔5 mg每日一次治疗，临床症状有显著改善。两年后重复进行运动负荷超声心动图检查，发现功能能力明显改善，运动高峰时无室内压差。作者讨论了这种在老年人中未被怀疑的症状原因的临床重要性。
