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患者男,41岁,反复胸闷、心前区疼痛3年,发作时呈隐痛伴压迫感,无放散,持续数分钟至数小时不等,与劳累及情绪激动无关。含服硝酸甘油症状不能缓解。因发病时心电图有“心肌缺血”改变,曾在当地医院诊为“冠心病、心绞痛”。既往无高血压及风湿热史,近2个月发作频繁,症状加重来诊。入院查体:BP18/11kPa,无紫绀,卧位无颈静脉怒张,两肺呼吸音清,无罗音,心界无扩大,心率76次/分,律齐,心尖部及胸骨左缘三、四肋间闻及Ⅱ级收缩期杂音,柔和无传导,A_2>P_2。ECG示:R I、Ⅱ、avL1.2～1.5mV,Rv4～v62.4～3.0mV,S—T I、Ⅱ、avl下移0.5～1.0mV,S—Tv4～v6下移2.0～3.0mV,TI、Ⅱ、avL倒置,Tv4～v6呈巨型倒T,波幅1.0～1.5mV。X线胸片:心肺影正常。超声心动图:左室心尖部增厚达1.7cm,余室壁厚度及室腔大小正常范围。主动脉瓣呈二叶纵裂式,开放无受限。彩色多普勒测及主动脉瓣轻度返流。冠脉造影未发现异常。同位素心肌显象见心尖肥厚部放射性分布稀疏。肝肾功能及电解质检查均正常。确诊为先天性二叶主动脉瓣,心尖肥厚型心肌病。经休息及钙离子拮抗剂、小剂量β受体阻滞剂治疗,症状缓解后出院。
Male, 41 years old, repeated chest tightness, pain in the precordial area for 3 years, the onset of pain was with pressure, no discharge, lasting several minutes to several hours, and fatigue and emotional agitation. Including nitroglycerin symptoms can not be alleviated. Due to the onset of electrocardiogram “myocardial ischemia” change, a local hospital diagnosed as “coronary heart disease, angina.” No previous history of hypertension and rheumatic fever, frequent seizures in recent 2 months, the symptoms increased to diagnosis. Admission examination: BP18 / 11kPa, no cyanosis, lying without jugular venous distention, lung breath sounds clear, no Luo Yin, no expansion of the heart, heart rate 76 beats / min, law Qi, apical and sternal left margin , Intercostal smell and Ⅱ systolic murmur, soft non-conduction, A_2> P_2. ECG showed: RI, Ⅱ, avL1.2 ~ 1.5mV, Rv4 ~ v62.4 ~ 3.0mV, S-TI, Ⅱ, avl down 0.5 ~ 1.0mV, S-Tv4 ~ v6 down 2.0 ~ 3.0mV, TI , Ⅱ, avL inversion, Tv4 ~ v6 giant inverted T, amplitude 1.0 ~ 1.5mV. X-ray: normal heart and lung shadow. Echocardiography: Left ventricular apical thickening up to 1.7cm, residual wall thickness and normal size of the chamber size. Aortic valve was two lobes, open without restriction. Color Doppler and mild aortic regurgitation. Coronary angiography found no abnormalities. Isotope myocardial imaging see apical hypertrophic sparse radioactivity distribution. Liver and kidney function and electrolyte tests were normal. Diagnosis of congenital two-lobe aortic valve, apical hypertrophic cardiomyopathy. After resting and calcium antagonists, low-dose beta-blocker treatment, the symptoms were relieved after discharge.