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患者女、54岁。因劳累后胸闷、气促、心悸5年,加重1年入院。 患者10年前突感心悸,心电图示心动过速,以后偶有心悸。近5年来劳累后感胸闷、气促、心悸,休息后缓解。近1年来上述症状加重,并出现 一过性晕厥。查体:心界略向左扩大,每分钟有5～6次早搏,P_2亢进,胸骨左缘四、五肋间可闻及Ⅳ级收缩期反流性杂音。心电图示右心房大,偶发室性早搏,心脏X光片显示左心缘第二弓扩大,右心室增大,肺门动脉扩张。彩色多普勒心脏超声检查及静脉心血管造影均证实右房右室增大,原发性肺动脉高压(重度)、三尖瓣反流(重度),无右向左分流。临床诊断:原发性肺动脉高压(重度)。 原发性肺动脉高压病因不明,以肺血管阻力和肺动脉压显著增高为特点。本例患者年龄偏大,自觉症状较轻,比较少见,如不进行彩色多普勒心脏超声、静脉心血管造影检查,极易漏诊,贻误治疗。
Female patient, 54 years old. Due to fatigue after chest tightness, shortness of breath, palpitations 5 years, increased 1 year admission. 10 years ago, patients with sudden heart palpitations, ECG showed tachycardia, after occasional heart palpitations. Over the past 5 years tired after feeling chest tightness, shortness of breath, palpitations, rest after remission. The past year, the above symptoms worsened, and a transient syncope. Physical examination: heart slightly to the left to expand, every 5 to 6 times premature beats, P 2 hyperthyroidism, sternal left edge of four or five intercostal can be heard and Ⅳ systolic reflux murmur. ECG right atrium, occasional ventricular premature beats, X-ray film showed the second left arch heart arch expansion, right ventricular enlargement, hilar artery dilatation. Color Doppler echocardiography and intravenous angiography confirmed right atrium right ventricular enlargement, primary pulmonary hypertension (severe), tricuspid regurgitation (severe), no right-left shunt. Clinical diagnosis: Primary pulmonary hypertension (severe). The underlying cause of primary pulmonary hypertension is characterized by a marked increase in pulmonary vascular resistance and pulmonary arterial pressure. The patients were older, less conscious symptoms, relatively rare, if not for color Doppler echocardiography, intravenous cardiovascular angiography, easily missed diagnosis, delaying treatment.