Yamano Michiyo, Kawasaki Tatsuya, Shiraishi Hirokazu, Kamitani Tadaaki, Shima Takatomo, Nakamura Takashi, Matoba Satoaki
Tex Heart Inst J. 2018 Apr 7;45(2):102-105. doi: 10.14503/THIJ-17-6238. eCollection 2018 Apr.
A diastolic paradoxical jet flow, often seen in patients with hypertrophic cardiomyopathy, is a unique flow from the apex toward the base of the left ventricle during isovolumic relaxation. To date, this phenomenon appears to have been noninvasively detected only on echocardiograms. We report the case of a 43-year-old man with hypertrophic cardiomyopathy and a diastolic paradoxical jet flow, in whom cardiac auscultation revealed a soft S, a systolic ejection murmur, and a low-pitched early diastolic murmur immediately after S at the apex. On comparing his echocardiographic findings with those on phonocardiograms and apexcardiograms, we confirmed that the unusual murmur coincided with the diastolic jet flow. To our knowledge, this is the first case in which heart murmurs associated with a diastolic paradoxical jet flow have been clearly described. Because these flows can increase the risk of adverse outcomes, detecting any associated murmurs by methods other than echocardiography is worthwhile, even in the era of advanced imaging techniques.
舒张期矛盾性射流通常见于肥厚型心肌病患者，是等容舒张期从心尖向左心室底部的一种独特血流。迄今为止，这种现象似乎仅在超声心动图上被无创检测到。我们报告一例43岁患有肥厚型心肌病及舒张期矛盾性射流的男性患者，其心脏听诊发现心音柔和、有收缩期喷射性杂音以及在心尖部S2后立即出现的低调舒张早期杂音。通过将他的超声心动图结果与心音图和心尖搏动图结果进行比较，我们证实了这种异常杂音与舒张期射流一致。据我们所知，这是首次明确描述与舒张期矛盾性射流相关的心杂音的病例。由于这些血流会增加不良结局的风险，即使在先进成像技术时代，通过超声心动图以外的方法检测任何相关杂音也是值得的。
