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ID:44564680
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页数:7页
时间:2019-10-23
《肥厚型心肌病49例临床分析》由会员上传分享,免费在线阅读,更多相关内容在工程资料-天天文库。
1、肥厚型心肌病49例临床分析作者:余秉东,胡建华,贾绍斌,张学虎作者单位:宁夏医科大学附属医院,宁夏银川750004【摘要】冃的分析肥厚型心肌病(HCM)的临床表现和辅助检查特点,以探索更合理的诊断方法。方法总结49例HCM住院病人的临床表现、心电图(ECG)、超声心动图(UCG)、核素心肌断层显像、磁共振(MRI)、冠状动脉和左室造影术(CAG+LVG)特点。结果49例ECG均为窦性心律,其中4例正常,45例分别表现为左室高电压、ST・T改变、T波深倒而双肢对称、Q波窄而深及各种心律失常,6例心尖部肥厚型心肌病(AHCM)患者ECG显示V3-5R波振幅增高伴V2-6对称性明显
2、倒置T波;49例UCG检查发现室间隔、心尖部不对称增厚;14例核素心肌断层显像检查发现核素分布异常;7例MRI均显示室间隔或心尖部心肌肥厚,室间隔最厚可达30mm。结论凡中、青年患者出现不典型胸痛、晕厥,体格检查发现有心前区收缩期杂音伴第三心音和(或)第四心音,ECG有缺血性ST-T改变和(或)异常Q波,但临床上难以用冠心病、高血压病和心瓣膜病来解释者,应考虑HCM,进」步UCG常规检查可以明确。近年来冠脉多排螺旋CT(MSCT)对HCM与冠心病的鉴别诊断有独到的优势。【关键词】肥厚型心肌病,诊断[Abstract]ObjectiveTostudytheclinicalcha
3、racteristicsof49caseswithhypertrophiccardiomyopathy(HCM)andimprovetheclinicaldiagnosisofHCM.Methods49caseshospitalizedwithHCMduringJan.2002toFeb・2008werestudiedbywithclinicalcharacteristics,electrocardiography(ECG),echocardiography,radionuclidemyocardialscanning,magneticresonanceimaging(MRI
4、),coronaryangiography(CAG)andleftventriculography(LVG).Results49caseswereallsinusrhythmbutonly4caseshavenormalECG,andECGshowedincreasedamplitude,theST-Tchanging,thedeepandinverseTwaveswithsymmetryarms,thedeepnarrowlyQwavesandvariouskindsofarrhythmiain45cases・ECGshowedincreasedRamplitudeinch
5、estV3-5leadsandinvertedTinchestV2・6leadsin6casesofapicalhypertrophiccardiomyopathy(AHCM).Thickeningofinterventricularseptum(IVS),leftventricularapicalwallandposteriorwallwasfoundwithechocardiographyin49cases.IVSorLeftventricularapicalwallwasabnormalbyradionuclidemyocardialscanningin14cases.
6、ThickeningofIVSorleftventricularapicalwallwasfoundwithLVG,CAGandMRI.ConclusionsHCMshouldbeconsideredforatypicalchestpain,syncope,precordialregionsystolicmurmurwithS3andS4,ischemicST-TchangingandabnormalQwaves.Thesurediagnosiscanbemadebyroutineechocardiography.ThecharacteristicintheECGarethe
7、importantsignsforclinicaldiagnosisofHCM・Echocardiographyisabasiccheckandnoticesthehypertrophy・[Keywords]Hypertrophiccardiomyopathy;Diagnosis肥厚型心肌病(HCM)以心肌不对称肥厚为主要特征,主要影响左心室⑴,其症状无特异性,易被误诊为冠心病。现将我院2002年1月・2008年2月收治的49例HCM患者资料报告如下。1资料与方法1.1一般资料:收集49例HCM患者,其
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