経年的に特異な心電図変化を示した長距離ランナーの1例

A Case of an Athlete Showing HCM-like Negative T which Expanded from the Right Precodial Leads to the Left Precordial and Limb Leads

　患者は38歳，男性．心電図上，II,III,aV_F，V₁〜V₆の陰性T波を認め，37歳のときに近医より精査目的で当科に紹介された．症例は13歳の頃より毎日20kmのランニングを続けており，ここ数年は週に1回10km，週に6回5kmのランニングを行っている．特に自覚症状はない．31歳のとき近医で心電図検査を受け，IIIとV₁〜V₃に陰性T波を認めた．以後次第に陰性T波は拡大し，36歳時にはaV_R，aV_L以外のすべての誘導でT波が陰転化した．当科での心エコー図検査，タリウム心筋シンチ，MRIなどの検査において虚血による変化あるいは心筋症を示唆する所見は認めず，スポーツ心臓と診断した．経年的に陰性T波の進行する症例においては，心筋症をはじめ病的心との鑑別が困難であり，対処に苦慮することがある．この症例のように比較的短期間のうちに著しい心電図変化を認めるのは稀であり，今後慎重な経過観察が必要と考えられる．

A 38-year-old man was introduced to our department because of an abnormal ECG. The ECG displayed nega-tive T waves in leads of V₁ to V₆, II, III and aV_F. He had enjoyed running for 20 km a day since the age of 13. Seven years ago, negative T waves in leads of V₁ to V₃ were first pointed out by his home-doctor. Six years ago, the negative T waves were recognized in leads of V₁ to V₅, II, III and aV_F. MRI and UCG showed no evidence of HCM and exercise Tl-scintigram induced no ST-T changes in ECG or perfusion defect. Negative T waves in the left precordial leads have rarely been recognized in the heart of an athlete. This case is specific and very rare, since negative T waves expanded from the right precordial leads to the left precordial and limb leads over a period of 7 years. At the present time, we have diagnosed this case as athlete's heart. A careful follow-up study is needed to distinguish whether this is the initial stage of cardiomyopathy or sport induced-myocardial damage.