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目的:报告并分析心尖肥厚性心肌病(AHCM)误诊的原因。方法:对15例误诊为“冠心病、心内膜下心肌梗塞”的AHCM患者的临床特征、心电图、心脏超声、冠状动脉造影(冠脉造影)、左心室造影进行分析,探讨其误诊原因。结果:15例均具有心尖肥厚性心肌病典型心电图表现。经胸心脏超声左心室心尖短轴测量心尖最厚处达18～22 mm,收缩末心尖部心腔缩小近于闭塞。经冠脉造影显示15例都未能诊断冠心病。X线右前斜位30度电影下显示左心室腔舒张期呈“黑桃”样变化,左心室心尖部较前壁明显增厚,并且心尖部活动幅度很弱。结论:临床医师对AHCM的诊断缺乏认识和超声科医师未能常规行心尖短轴切面检查是引起15例心尖肥厚性心肌病患者误诊的主要原因。
Objective: To report and analyze the causes of misdiagnosis of apical hypertrophic cardiomyopathy (AHCM). Methods: The clinical features, electrocardiogram, echocardiography, coronary angiography (CAG) and left ventricular angiography in 15 cases of AHCM misdiagnosed as “coronary heart disease and subendocardial myocardial infarction” were analyzed to investigate their misdiagnosis the reason. Results: All of the 15 cases showed typical electrocardiogram of apical hypertrophic cardiomyopathy. Transthoracic echocardiography of the left atrial apical short axis measurement of the apex of the thickness of 18 ~ 22 mm, systolic apical systolic cavity close to occlusion. Coronary angiography showed that 15 cases failed to diagnose coronary heart disease. Right anterior oblique X-ray film at 30 degrees showed left ventricular diastolic was “Spades” -like changes, left ventricular apex thicker than the anterior wall, and the apex amplitude is very weak. Conclusion: The clinicians lack of understanding of the diagnosis of AHCM and the lack of routine apical short axis examination by the sonographer are the main causes of misdiagnosis in 15 patients with apical hypertrophic cardiomyopathy.