Kinoshita N, Sugihara H, Nakamura T, Ito K, Kawata K, Tatsumi T, Azuma A, Nakagawa M
Second Department of Medicine, Kyoto Prefectural University of Medicine.
Kaku Igaku. 1997 Nov;34(11):1021-6.
We reported a 47-year-old female with congestive heart failure (CHF) of unknown origin. In this case, it was suggested that 123I-BMIPP and 99mTc-tetrofosmin myocardial SPECT images were useful in the diagnosis of CHF of unknown origin. She had complained of easy fatigability and dyspnea on effort since Sep. 1995. She was admitted to our hospital because of worsening of symptoms in Dec. 1995. Slightly decreased uptake in anterior, lateral and apical walls was recognized in 99mTc-tetrofosmin SPECT images, meanwhile 123I-BMIPP SPECT images showed markedly reduced uptake in the same areas. This discordance in the distribution between 123I-BMIPP and 99mTc-tetrofosmin myocardial SPECT suggested that CHF was not due to dilated cardiomyopathy, but ischemic myocardial disease. Coronary angiography revealed 90% stenosis at the just proximal of left coronary artery. This case was diagnosed an isolated coronary ostial stenosis with CHF, because she was menstruated middle aged woman and did not have a history of aortitis syndrome, syphilis and coronary risk factor before.
我们报告了一名47岁不明原因充血性心力衰竭（CHF）的女性患者。在此病例中，123I - BMIPP和99mTc - 替曲膦心肌SPECT图像对不明原因CHF的诊断有帮助。自1995年9月起，她就一直诉说容易疲劳且活动时呼吸困难。1995年12月，因症状加重而入院。99mTc - 替曲膦SPECT图像显示前壁、侧壁和心尖壁摄取略减少，同时123I - BMIPP SPECT图像显示相同区域摄取明显减少。123I - BMIPP与99mTc - 替曲膦心肌SPECT分布的这种不一致表明CHF并非由扩张型心肌病引起，而是缺血性心肌疾病。冠状动脉造影显示左冠状动脉近端正好有90%的狭窄。该病例被诊断为孤立性冠状动脉口狭窄伴CHF，因为她是中年经绝期女性，且之前没有主动脉炎综合征、梅毒和冠状动脉危险因素病史。
