Sheikhzadeh A, Ghabussi P
Jpn Heart J. 1982 Sep;23(5):843-9. doi: 10.1536/ihj.23.843.
Clinical, hemodynamic, electrocardiographic (ECG), echocardiographic, left ventricular (LV), and coronary angiographic (CA) findings are reported in a case with apical hypertrophy (AH), a form of hypertrophic nonobstructive cardiomyopathy (HNCM). The most striking symptom was chest pain and the most conspicuous electrocardiographic finding consisted of giant negative T waves, reaching an amplitude of 4.0 mV. Echocardiography revealed an apical thickness of the septum and posterior wall of 40 mm; this was significantly greater than septal and posterior free wall thickening in the LV outflow area. The anterior motion (SAM) of the anterior mitral leaflet, was present, and, in hemodymic investigation, the isoproterenol test was negative. The left ventricular end-diastolic pressure (LVEDP) and the EF were elevated. In the LV angiogram from the right anterior oblique position (RAO), the LV free wall thickness at the apex was significantly thicker than at the outflow tract level. The patient had dilated coronary arteries. We conclude that these findings are typical for AH (HNCM) and it seems that hypertrophic obstructive cardiomyopathy (IHSS, MO), and hypertrophic non-obstructive cardiomyopathy (ASH, AH) are different manifestations of a wide spectrum of hypertrophic cardiomyopathy.
本文报告了一例心尖肥厚型心肌病（AH）患者的临床、血流动力学、心电图（ECG）、超声心动图、左心室（LV）及冠状动脉造影（CA）检查结果。AH是肥厚型非梗阻性心肌病（HNCM）的一种类型。该患者最显著的症状是胸痛，最突出的心电图表现为巨大倒置T波，振幅达4.0 mV。超声心动图显示室间隔及后壁心尖部厚度为40 mm，显著大于左心室流出道区域的室间隔及后壁游离壁增厚程度。二尖瓣前叶存在前向运动（SAM），血流动力学检查中异丙肾上腺素试验为阴性。左心室舒张末期压力（LVEDP）及射血分数（EF）升高。在右前斜位（RAO）左心室血管造影中，心尖部左心室游离壁厚度明显厚于流出道水平。患者冠状动脉扩张。我们得出结论，这些表现是AH（HNCM）的典型特征，肥厚型梗阻性心肌病（IHSS，MO）和肥厚型非梗阻性心肌病（ASH，AH）似乎是肥厚型心肌病广泛谱系中的不同表现形式。
