Pearse Simon G, Missouris Constantinos, Qureshi Muhammad Ali
Department of Cardiology, Wexham Park Hospital, Slough, UK.
BMJ Case Rep. 2014 Jun 3;2014:bcr2014204468. doi: 10.1136/bcr-2014-204468.
A 65-year-old normotensive, non-athletic man presented to the cardiology clinic with exertional dyspnoea and chest discomfort. Echocardiography revealed mild left ventricular hypertrophy with good systolic function but with regional wall motion abnormalities suggesting ischaemia. Coronary angiography showed significant three-vessel disease. He underwent coronary artery bypass surgery, which was complicated by recurrent pericardial and pleural effusions, requiring a pericardial window procedure. Over the following year he became increasingly oedematous and breathless. On ECG the complexes were low voltage with impaired R wave progression and atrial fibrillation. Echocardiography revealed progression of the left ventricular hypertrophy (LVH) with a bright myocardium and restrictive filling pattern. MRI scanning confirmed the diagnosis of cardiac amyloidosis. He was referred for transplant but was considered unsuitable due to extensive mediastinal scarring. This case demonstrates the importance of a high index of suspicion for amyloidosis, especially in patients with unexplained LVH. Cardiac MRI or biopsy may expedite the diagnosis.
一名65岁血压正常、非运动员男性因劳力性呼吸困难和胸部不适就诊于心脏病诊所。超声心动图显示轻度左心室肥厚，收缩功能良好，但存在提示缺血的节段性室壁运动异常。冠状动脉造影显示三支血管严重病变。他接受了冠状动脉搭桥手术，术后并发反复心包积液和胸腔积液，需要进行心包开窗术。在接下来的一年里，他水肿和呼吸困难日益加重。心电图显示各波电压低，R波递增不良及房颤。超声心动图显示左心室肥厚（LVH）进展，心肌呈明亮表现及限制性充盈模式。心脏磁共振成像扫描确诊为心脏淀粉样变性。他被转诊进行移植评估，但由于广泛的纵隔瘢痕而被认为不适合。该病例表明对淀粉样变性保持高度怀疑的重要性，尤其是在不明原因LVH患者中。心脏磁共振成像或活检可加快诊断。
