Komiyama N, Nishiyama S, Nakanishi S, Nishimura S, Kato K, Seki A, Daida H, Takaya J, Yamaguchi H
Cardiovascular Center, Toranomon Hospital, Tokyo.
J Cardiol. 1989 Sep;19(3):805-13.
Among 144 patients with hypertrophic cardiomyopathy, eight (58.3 +/- 7.0 years, M:F = 7:1) had complicating myocardial infarction, which was diagnosed clinically and by elevated cardiac enzymes or new Q-waves on electrocardiography. Coronary occlusion or stenosis evidenced by coronary angiography and nuclear cardiological findings were investigated. In six of the eight patients, coronary atherosclerosis caused infarction. These patients had many coronary risk factors compared to the other two patients. Sixteen of the 144 patients (11%) with hypertrophic cardiomyopathy had coronary atherosclerosis, the rate of which is reportedly 10 to 20%. Two of the eight patients had no coronary atherosclerosis. One patient had a diffusely spastic diathesis provoked by the intravenous administration of ergonovine maleate during coronary angiography, suggesting that coronary spasm caused myocardial infarction. The other patient had recurrent episodes of supraventricular tachyarrhythmia and no evidence of spasm during coronary angiography, suggesting coronary embolism as a cause of myocardial infarction. Myocardial infarction in patients with hypertrophic cardiomyopathy and normal coronary arteries as advocated by Maron et al. may have such pathogenesis. We conclude that coronary angiography may be mandatory in patients with hypertrophic cardiomyopathy, especially those who have many coronary risk factors and anginal symptoms. In these patients, ST-T changes and abnormal Q-waves on electrocardiography sometimes may be misleading when diagnosing the occurrence of acute myocardial infarction by electrocardiography alone. In such cases, infarct-avid scintigraphy with 99 m-Tc pyrophosphate is preferable.
在144例肥厚型心肌病患者中，8例（年龄58.3±7.0岁，男:女=7:1）并发心肌梗死，根据临床表现、心肌酶升高或心电图出现新的Q波作出诊断。对冠状动脉造影及核素心脏检查所显示的冠状动脉闭塞或狭窄情况进行了研究。8例患者中有6例，冠状动脉粥样硬化导致了心肌梗死。与另外2例患者相比，这些患者有许多冠状动脉危险因素。144例肥厚型心肌病患者中有16例（11%）存在冠状动脉粥样硬化，据报道其发生率为10%至20%。8例患者中有2例无冠状动脉粥样硬化。1例患者在冠状动脉造影期间静脉注射马来酸麦角新碱后出现弥漫性痉挛素质，提示冠状动脉痉挛导致心肌梗死。另1例患者有室上性快速心律失常反复发作，冠状动脉造影期间无痉挛证据，提示冠状动脉栓塞是心肌梗死的病因。Maron等人所主张的肥厚型心肌病且冠状动脉正常患者发生的心肌梗死可能有这样的发病机制。我们得出结论，对于肥厚型心肌病患者，尤其是那些有许多冠状动脉危险因素和心绞痛症状的患者，冠状动脉造影可能是必要的。在这些患者中，仅通过心电图诊断急性心肌梗死发生时，心电图上的ST-T改变和异常Q波有时可能会产生误导。在这种情况下，用99m锝焦磷酸盐进行梗死灶显像是更可取的。
