Unstable Angina Associated with Myocardial Bridging and Hypertrophic Cardiomyopathy

不穩定性心絞痛伴隨心肌橋及肥厚性心肌病變

林志達(Chih-Ta Lin) ； 林庭光(Tin-Kwang Lin)

《內科學誌》 19卷3期 (2008/06) Pp. 260-265

https://doi.org/10.6314/JIMT.2008.19(3).10

摘要

一位48歲男性病患因持續性胸悶，伴隨有冒冷汗、低血壓及心博過速的情形而住院。心電圖顯示竇性心博過速及非特異性ST-T段變化。一連串的心肌酵素測量並沒有升高。臨床上根據病人的臨床表現診斷爲不穩定性心絞痛。冠狀動脈血管攝影顯示冠狀動脈本身並無粥狀硬化的情形，但是在左前降支動脈中段有嚴重心肌橋，導致左前降支動脈在心臟收縮期時幾乎完全阻塞。另外心臟超音波顯示病人合併有肥厚性阻塞型心肌病變。病人胸悶的症狀經過bisoprolol及verapamil治療後緩解。心肌橋和肥厚性心肌病變兩者皆可能引起心肌缺血並且都可以用鈣離子阻斷劑及乙形阻斷劑加以治療。冠狀動脈支架置放可以治療心肌橋但再狹窄率偏高。而心肌切開術或冠狀動脈繞道手術及經主動脈瓣膜下心肌切除術應保留給內科治療失敗的病人。

並列摘要

A 48-year-old man was admitted due to persistent chest tightness associated with cold sweats, hypotension and tachycardia. An electrocardiogram showed a sinus tachycardia with non-specific ST-T changes. Serial cardiac isoenzymes were not elevated. Unstable angina was diagnosed based on the clinical manifestations. Coronary angiography revealed no evidence of atherosclerosis but severe myocardial bridging in the middle third of the left anterior descending coronary artery which resulted in nearly total occlusion of the vessel in systole. Meanwhile, an echocardiogram revealed hypertrophic obstructive cardiomyopathy. The patient did well under medical treatment with bisoprolol and verapamil. In conclusion, both myocardial bridging and hypertrophic cardiomyopathy can cause myocardial ischemia and can be treated by calcium antagonists and/or beta-blocking agents. Coronary stenting can be performed to relieve the myocardial bridging but restenosis rate is high. Surgical myotomy or coronary artery bypass graft and transaortic subvalvular myectomy should be reserved when patients are refractory to medical treatment.

並列關鍵字

Unstable angina ； Myocardial bridging ； Hypertrophic obstructive cardiomyopathy