Suzuki K, Aizawa Y, Tamura M, Funazaki T, Miyajima S, Niwano S, Chinushi M, Sato M, Ebe K, Shibata A
First Department of Internal Medicine, Niigata University School of Medicine.
J Cardiol Suppl. 1989;21:119-25, discussion 126-7.
A 27-year-old woman had a history of palpitation at the age of nine. Ventricular tachycardia (VT) was detected four years ago and treatment with procainamide was started. Physical examination disclosed nothing abnormal other than an apical mid-systolic click. Electrocardiogram and chest radiograph were normal, and echocardiogram disclosed borderline mitral valve prolapse (MVP). VT was not provoked by exercise, and Holter monitorings of electrocardiogram were always within a normal limit. Angiography was normal. Electrophysiological study disclosed VT by left ventricular stimulation and the earliest activation was at the apex, VT was abolished by early stimulation from the right ventricular apex. The association of a mid-systolic click and VT was interesting in this case. When the patient had a systolic click at the outpatient clinic, VT frequently occurred within a month (six of seven times), while VT did not occur without an audible systolic click (three of four times). Although it is uncertain whether VT of this patient has any relationship to MVP or to the click, these problems remain to be solved in the future.
一名27岁女性9岁时曾有心悸病史。四年前检测到室性心动过速（VT），并开始使用普鲁卡因胺治疗。体格检查除心尖部收缩中期喀喇音外未发现异常。心电图和胸部X线片正常，超声心动图显示二尖瓣脱垂（MVP）临界。运动未诱发VT，动态心电图监测始终在正常范围内。血管造影正常。电生理研究显示左心室刺激可诱发VT，最早激动位于心尖，右心室心尖部早期刺激可消除VT。本病例中收缩中期喀喇音与VT的关联很有意思。当患者在门诊出现收缩期喀喇音时，VT常在一个月内频繁发作（七次中有六次），而无听诊到的收缩期喀喇音时VT不发作（四次中有三次）。虽然尚不确定该患者的VT与MVP或喀喇音是否有任何关系，但这些问题仍有待今后解决。
