Sueda S, Hamada M, Shigematsu Y, Sekiya M, Kazatani Y, Ochi T, Ito T, Kokubu T
J Cardiogr. 1984 Oct;14(3):597-604.
A 48-year-old man with hypertrophic obstructive cardiomyopathy (HOCM) was studied by serial cardiac catheterization during incidentally induced syncope. His hospital admission was for repeated syncopal attacks and chest pain. His electrocardiogram showed giant negative T waves (greater than 10 mm) in V3, V4 and V5 leads, and his M-mode echocardiogram disclosed typical asymmetric septal hypertrophy, systolic anterior movement of the mitral valve, and a midsystolic semiclosure of the aortic valve. During cardiac catheterization, we incidentally induced syncope and recorded the serial pressure changes. During syncope, systemic blood pressure dropped without appreciable changes in pulmonary arterial and right ventricular pressures. Although blood pressure was maintained by administering etilefrine and hydrocortisone, syncope persisted. After administration of propranolol, he recovered from syncope. He was on sinus rhythm throughout the examinations. The ejection time (ET) obtained from the aortic pressure curve was extremely short (160 msec) during syncope and prolonged (300 msec) after recovery without significant change in the heart rate. We believe that the prompt intravenous administration of propranolol was very effective in relieving myocardial spasm as a possible cause of syncope.
一名48岁的肥厚型梗阻性心肌病（HOCM）男性患者，在偶然诱发晕厥期间接受了系列心脏导管检查。他因反复晕厥发作和胸痛入院。他的心电图显示V3、V4和V5导联出现巨大负向T波（大于10毫米），其M型超声心动图显示典型的不对称性室间隔肥厚、二尖瓣收缩期前向运动以及主动脉瓣收缩中期半关闭。在心脏导管检查期间，我们偶然诱发了晕厥并记录了系列压力变化。晕厥期间，全身血压下降，肺动脉和右心室压力无明显变化。尽管通过给予依替福林和氢化可的松维持了血压，但晕厥仍持续。给予普萘洛尔后，他从晕厥中恢复。在整个检查过程中他维持窦性心律。从主动脉压力曲线获得的射血时间（ET）在晕厥期间极短（160毫秒），恢复后延长（300毫秒），心率无明显变化。我们认为，迅速静脉注射普萘洛尔对于缓解作为晕厥可能原因的心肌痉挛非常有效。
