急性心筋梗塞を合併したうっ血型心筋症の1例

A case of acute myocardial infarction in idiopathic congestive cardiomyopathy

　うっ血型心筋症は原因や病態に不明な点が多く，虚血性心疾患との鑑別も困難な場合がある。一方，本症の合併症として最も頻度が高いのは血栓，塞栓症であり，その他循環器系合併症として心室細動，心房中隔欠損，僧帽弁狭窄，心外膜炎などが報告^1）されているが，本症の経過中に急性心筋梗塞を合併した例はIsner^2）らが1例報告している他はほとんど報告がない。本邦のうっ血型心筋症の統計でも，急性心筋梗塞の合併が確かめられた報告はわれわれが調べた限りではないようである。

　今回われわれは，うっ血型心筋症として経過観察中に急性心筋梗塞を合併してpump failureに陥った1例を経験したので，本症と虚血性心疾患との鑑別に関しての考察を加えて報告する。

A 44-year-old man was admitted to our hospital with anterior chest pain in July, 1979. He had been treated as idiopathic congestive cardiomyopathy for three years before this attack. On this admis-sion he complained of chest pain and dyspnea and fell in pump failure. ECG revealed elevation of ST segments in V²-V⁶ and serum GOT, CPK and CPK-MB elevated significantly. From these clinical findings we diagnosed acute myocardial infarction occurred.

Pump failure was improved by dopamine and Glucose-Insulin-Potassium solution in two weeks. Nevertheless after three months pump failure prog-ressed again and led him to death afterall.

Autopsy was done. All four chambers of the heart were markedly dilated. There were three non-trans-mural scarrings at left ventricle and ventricular sep-tum. The major coronary arteries were normal. Histological examination showed diffuse degenera-tion of myocardium of all four chambers. Such case has been rarely reported that acute myocardial infarction was clinically and pathologically diagnos-ed in idiopathic congestive cardiomyopathy.