Kageyama F, Iida H, Yositomi A, Ikegaya H, Okano H, Fujimoto K, Tagata M, Nagao M, Yosimi T, Itou T
Internal Medicine, Haibara General Hospital.
Kokyu To Junkan. 1993 Jan;41(1):69-73.
A 72-years-old woman was admitted to our hospital for evaluation of giant negative T waves, which appeared for only two days. Chest X-p revealed a cardiomegaly of slight degree and UCG showed ASH (IVS = 21 mm). Coronary arteriography presented no significant stenosis and the left ventricle was spade-shaped. There was a pressure gradient of 65 mmHg between the aorta and the left ventricle during isoproterenol infusion. Furthermore, endomyocardial biopsy showed disarray and fibrosis to a slight degree and fatty degeneration of myocytes with contraction bands. Based on these findings, calcium blocker was administrated under the diagnosis of HOCM. One month after the initiation of this drug, negative T waves gradually became shallow and finally upright with thinning of IVS (12 mm) four month later. We swimise that this T-wave change is primarily based on myocardial hypertrophy as well as being due to the abnormality of myocardial depolarization. We presented a case of HOCM with negative T-wave change of very short duration, which was improved by calcium-blocker and beta-blocker.
一名72岁女性因出现仅两天的巨大负向T波而入院接受评估。胸部X线显示轻度心脏扩大,超声心动图显示室间隔增厚(IVS = 21 mm)。冠状动脉造影未显示明显狭窄,左心室呈铲形。在输注异丙肾上腺素期间,主动脉与左心室之间存在65 mmHg的压力梯度。此外,心内膜活检显示有轻度排列紊乱和纤维化,以及带有收缩带的心肌细胞脂肪变性。基于这些发现,在诊断为肥厚型梗阻性心肌病(HOCM)的情况下给予钙通道阻滞剂治疗。开始使用该药物一个月后,负向T波逐渐变浅,四个月后最终转为正向,同时室间隔变薄(12 mm)。我们推测这种T波变化主要基于心肌肥厚以及心肌去极化异常。我们报告了一例肥厚型梗阻性心肌病伴极短持续时间的负向T波改变病例,该病例通过钙通道阻滞剂和β受体阻滞剂治疗得到改善。