高齢者の閉塞性心筋症に対する頸動脈波の診断的意義

Diagnostic value of carotid arterial pulse on hypertrophic obstructive cardiomyopathy seen in the elderly

　高齢者では収縮期雑音，心電図や胸部レ線写真上の左室肥大像がしばしば認められ，また高血圧や冠動脈疾患の頻度が高いので，閉塞性心筋症（Hypertrophic obstructive cardiomyopathy, HOCM）の診断は困難であるとされている^1,2）。私共は，この病態を把握するために頸動脈波の記録が簡潔にして重要であることを認めたので報告する。

Recordings of the carotid artery pulse made a diagnostic clue for three elderly patients with hypertrophic obstructive cardiomyopathy with ages of 66 years or more. All of them had been told to have congestive heart failure, mitral re-gurgitation or angina pectoris before visiting our clinic. A typical peak-dome pattern on the carotid artery pulse trace was shown without any provocative maneuvers in two patients, and with isoproterenol in the third patient. Asym-metric septal hypertrophy and systolic anterior motion of the mitral valve were documented on M-mode echocardiogram in all three patients.

The carotid artery pulse trace, therefore, pro-ved to be diagnostically important provided physiological alterations of the wave shape with aging are taken into account.