摘要
目的:分析46例致心律失常性右心室心肌病(ARVC)的临床特征,以期提高ARVC的诊断率,减少误诊率。方法:选择符合1994年欧洲心脏病协会诊断标准的ARVC患者46例,分析其临床表现、相关检查、诊治经过。结果:46例患者年龄3个月～75岁,男35例,女11例;临床症状为心悸、头晕者30例(65.2%),有心力衰竭症状者21例(45.7%),17例(37.0%)有晕厥史,3例(6.5%)有猝死家族史。28例(60.9%)静息心电图表现为平均QRS时程延长(>110ms),22例(47.8%)有epsilon(ε)波;46例患者均记录到不同类型的心律失常,同时并发3种及3种以上心律失常者23例(50.0%),持续性室性心动过速38例(82.6%)。全部患者入院时超声心动图检查平均右心室舒张末期内径(35.8±8.1)mm,左心房舒张末期内径(34.2±11.0)mm,左心室舒张末期内径(53.6±11.4)mm,左心室射血分数(44±20)%,共有16例患者行磁共振检查,2例患者行CT检查,其中显示右心房室扩大7例,并发右心室瘤样突出4例,有右心室脂肪浸润9例。6例患者行核素心血池显像均提示右心室扩大,右心室心功能重度受损,右心室射血分数(RVEF)(22±5)%。9例心脏移植患者病理检查提示左、右心室均有不同程度的心肌细胞萎缩、变性、坏死、纤维和脂肪组织大片的浸润,1例为右心室局灶性纤维组织增厚。10例首诊为扩张型心肌病,1例首诊为未分类心肌病,1例首诊为三尖瓣下移畸形,首诊误诊率为26.1%。结论:ARVC临床表现多样而复杂,误诊率高,应加强对ARVC的再认识以提高ARVC的诊断率。
Objective：To retrospectively analyze the clinical features of patients with arrythmogenic right ventricular cardiomyopathy （ARVC）. Method：The clinical features, diagnosis and treatment were analyzed in 46 patients （35 males） with ARVC according to the criteria established by European Society of Cardiology. Result：The averaged age was （42.4±19.5） years old （0. 25-75）. Palpitation was presented in 30 patients （65.2%）, heart failure in 21 patients （45.7%） , syncope in 16 patients（34.8%） and a family history of sudden death in 3 patients （6. 5%）. ECG changes included： the average QRS duration ≥110 ms （60.9%） ; epsilon （ε） wave （47.8%）; T wave inversion in precordial leads （78.3% ） ; reduced extremity amplitude （43.5 % ） ; arrhythmia in various types （23 patients including 3 types and more）. Dilated cardiomyopathy was diagnosed in 10 oatients, unclassified cardiomyopathy in one, Ebstein＇s anomaly in one and 26. 1% of patients were indefinited at the first visit. Conclusion; Complex clinical manifestations were showed in the patients with ARVC, with higher misdiagnosis rates. ARVC would be learned again to raise the correctness of final diagnosis.
出处
《临床心血管病杂志》
CAS
CSCD
北大核心
2008年第5期360-362,共3页
Journal of Clinical Cardiology
关键词
致心律失常右心室心肌病
心力衰竭
误诊
Arrhythmogenic right ventricular cardiomyopathy
Heart failure
Misdiagnosis
