College of Medicine.
Heart and Vascular Center, Division of Cardiology and.
Am J Med Sci. 2019 Oct;358(4):299-303. doi: 10.1016/j.amjms.2019.07.002. Epub 2019 Jul 13.
Apical hypertrophic cardiomyopathy is a variant of hypertrophic cardiomyopathy characterized by apical hypertrophy, deep T-wave inversions in precordial electrocardiogram (EKG) leads, and a ventriculogram shaped like the "Ace of Spades." Patients are often asymptomatic but sometimes present with atypical chest pain, angina, or atrial fibrillation. The deep T-wave inversions on EKG often mimic acute coronary syndrome. Coronary angiogram in these patients is unrevealing, but the characteristic left ventriculogram establishes this diagnosis. The deep T-wave inversions can appear suddenly or deepen over years, making the diagnosis difficult to establish early in the disease. Transthoracic echocardiogram may miss the hypertrophied apex, but echo contrast imaging or cardiac magnetic resonance imaging can reliably confirm the diagnosis and detect apical aneurysms. We present a case of apical hypertrophic cardiomyopathy which was not evident despite many admissions, EKGs, cardiac catheterizations and echocardiograms until the diagnosis was confirmed with left ventriculogram and cardiac magnetic resonance imaging 20 years after initial presentation.
心尖肥厚型心肌病是肥厚型心肌病的一种变体，其特征为心尖肥厚、胸前心电图（EKG）导联出现深 T 波倒置，以及心室造影呈“黑桃 A”样。患者通常无症状，但有时会出现非典型胸痛、心绞痛或心房颤动。心电图上的深 T 波倒置常常类似于急性冠状动脉综合征。这些患者的冠状动脉造影无异常，但特征性的左心室造影可确立该诊断。深 T 波倒置可突然出现或多年来逐渐加深，使得在疾病早期难以确立诊断。经胸超声心动图可能会漏诊心尖肥厚，但超声对比成像或心脏磁共振成像可以可靠地确认诊断并检测心尖瘤。我们报告一例心尖肥厚型心肌病病例，尽管多次入院、心电图检查、心导管检查和超声心动图检查，但直到 20 年后进行左心室造影和心脏磁共振成像才确诊。
