- 期刊
Combined Vasodepressive and Cardioinhibitory Syncope in a Patient with Hypertrophic Cardiomyopathy
肥厚型心肌病變患者合併有血管張力失調型及心臟抑制型昏厥
摘要
肥厚型心肌病變患者可經由數種機轉導致昏厥，自律神經失調是其中較少被報導的一種。本文報告一名五十八歲女性罹患高血壓、阻塞性肥厚型心肌病變及陳舊性中風。她經歷數次昏厥但原因不明。在某次發作時，診所醫師投予腎上腺素治療並轉至本院。一連串的檢查包括冠狀動脈攝影、心臟超音波、心臟電氣生理檢查及傾斜床檢查等皆無法找出病因。最後經由連續性血壓暨心律監視器紀錄了一次自發性低血壓伴隨心率下降，讓我們得以診斷為自律神經失調引起的迷走神經相關性昏厥(vagally mediated syncope)。經心臟節律器施予心率下降反應(rate drop response)治療，患者再接下來十二個月得到明顯改善。
並列摘要
Syncope occurring in patients with hypertrophic cardiomyopathy (HCM) can be triggered by several mechanisms, among which autonomic dysfunction is often ignored. A 58-year-old woman was transferred to our hospital after resuscitation with epinephrine. She had had several episodes of unexplained syncope before. Her medical history included hypertension, obstructive HCM, and old ischemic stroke. Subsequent tests to explore the underlying cause of syncope, including coronary angiography, echocardiography, electrophysiologic study, and tilt table test, were inconclusive. An episode of near-syncope, associated with spontaneous lowering of blood pressure and then slowing of heart rate, was finally recorded and it was diagnosed as vagally mediated syncope related to autonomic dysfunction. After a pacemaker was implanted with special feature of rate drop response (RDR), the patient rarely had syncope in the following 12 months.
延伸閱讀
- Lin, C. T., & Lin, T. K. (2008). 不穩定性心絞痛伴隨心肌橋及肥厚性心肌病變. 內科學誌, 19(3), 260-265. https://doi.org/10.6314/JIMT.2008.19(3).10
- Chen, C. K., & Chen, C. Y. (2008). Tako-tsubo心肌病變（暫時性左心室心尖球狀突出症候群）一病例報告. 中華民國急救加護醫學會雜誌, 19(1), 28-34. https://doi.org/10.30018/JECCM.200803.0006
- 陳正中、刁小倚（2009）。血管緊張素對運動性心臟肥大影響之探討。中華體育季刊，23(4)，1-8。https://doi.org/10.6223/qcpe.2304.200912.2001
- 張德宗、陳錦康、陳以成（1986）。肥厚性心肌病變的分類與內科治療。當代醫學，(157)，890-895。https://doi.org/10.29941/MT.198611.0010
- Liu, Y. C., Chiang, S. J., Chen, S. A., & Ko, J. T. (2004). 肥厚性阻塞性心肌病變於接受左心室中膈心肌切除術後發生延遲性房室傳導阻滯. 北市醫學雜誌, 1(4), 487-492. https://doi.org/10.6200/TCMJ.2004.1.4.14