诊断伴有动脉高血压的肥厚型心肌病的挑战:一个临床病例

IF 0.1 Q4 MEDICINE, GENERAL & INTERNAL
O. O. Khaniukov, L. Sapozhnychenko, O. Smolianova
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引用次数: 0

摘要

目的描述一例临床病例,并分析诊断合并动脉高血压(AH)患者的肥厚型心肌病(HCM)所面临的挑战。文章介绍了在第聂伯罗彼得罗夫斯克州委员会市级企业 "第聂伯罗彼得罗夫斯克地区临床诊断和治疗中心 "门诊环境中观察到的合并动脉高血压患者的肥厚型心肌病临床病例。一名 66 岁的女性 N 经家庭医生诊断患有冠状动脉疾病(CAD):稳定型心绞痛 FC II,2 级 AH,慢性心力衰竭 FC II NYHA,因出现劳累性呼吸困难、胸痛和血压无法控制而转诊至心脏科医生。心脏磁共振成像证实了诊断结果,冠状动脉造影排除了 CAD。考虑到 HCM 伴有 LVOT 阻塞,调整治疗方案后,患者的症状得到有效缓解,血压也趋于稳定。遵循 AH 管理指南并对所有高血压患者进行超声心动图检查尤为重要,以免错过并发 HCM(尤其是左心室出口梗阻)的征兆。此外,对于 HCM,有必要及时发现、预防和管理有心脏性猝死风险的患者。由于 HCM 包含多种诊断,发病机制各不相同,治疗方法也不尽相同,因此可能需要根据指南进行心脏磁共振成像、酶学或基因检测。由于 HCM 是一种较为常见的遗传性心脏病,普通医生在日常临床实践中经常会遇到此类患者,因此,对于左心室质量符合 HCM 标准的 AH 患者,他们应该对这一诊断有一定的怀疑。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The challenges in diagnosing hypertrophic cardiomyopathy in the presence of arterial hypertension: a clinical case
Aim. To describe a clinical case and analyze the challenges in diagnosing hypertrophic cardiomyopathy (HCM) in a patient with concomitant arterial hypertension (AH). Materials and methods. The article presents the clinical case of HCM in the patient with concomitant AH that was observed in an ambulatory setting in the Municipal Enterprise “Dnipropetrovsk Regional Clinical Center for Diagnostics and Treatment” of Dnipropetrovsk Regional Council. Results. A 66-year-old woman N., diagnosed by her family physician with coronary artery disease (CAD): stable angina FC II, grade 2 AH, chronic heart failure FC II NYHA, was referred to a cardiologist because of experiencing exertional dyspnea, chest pain, and uncontrolled blood pressure despite treatment compliance. Echocardiography identified concentric left ventricular hypertrophy with the left ventricular outflow tract (LVOT) obstruction (a mean gradient of 35 mmHg as per catheterization). Cardiac MRI confirmed the diagnosis and coronary angiography ruled out CAD. Adjustments to the treatment regimen, taking into account HCM with LVOT obstruction, effectively alleviated the patient’s symptoms and stabilized her blood pressure. Conclusions. It is especially important to follow the guidelines of AH management and perform echocardiography in all patients with high blood pressure, so as not to miss the signs of concomitant HCM, particularly with LVOT obstruction. In addition, in the case of HCM, it is necessary to timely detect, provide prevention and manage patients at risk for sudden cardiac death. Since HCM encompasses various diagnoses with different pathogenesis and distinct management, cardiac MRI, enzymatic or genetic testing may be needed according to guidelines. As HCM is a relatively common inherited cardiac disease, general practitioners could often encounter such patients in everyday clinical practice. Hence, they should have a certain suspicion of this diagnosis in persons with AH whose left ventricular mass meets the criteria for HCM.
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来源期刊
Zaporozhye Medical Journal
Zaporozhye Medical Journal MEDICINE, GENERAL & INTERNAL-
自引率
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发文量
72
审稿时长
8 weeks
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