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由体位改变所致的3相性阵发性房室传导阻滞少见报告。现将我们遇到的1例报告如下。患者男性,75岁,高血压病史8年(高时达170/120),反复发作晕厥2年,近2月活动后胸闷、气短、头昏等症状加重,且多于立位时发生。临床诊断高血压性心脏病,冠心病。入院后查心电图示窦性心律为60次/分,电轴左偏-30°,完全性右束支阻滞,左室肥大。X线胸片示主动脉弓迂曲、增宽,左心缘饱满。实验室检查三大常规,血糖、血脂均正常。1985年3月29日起床后突感胸闷、气急、头晕,当即心脏听诊心率约30—40次/分,律不齐,并立即查立位和卧位心电图。立位(附图上、中行,见第103页)Ⅱ导联示高度房室传导阻滞,心房率约80次/分,室性逸搏心律室率约40次/分,第3个心搏为心室夺获。立位V_1导联呈3:1房室传导,倒数第2个QRS波为室性早搏,在此之前的QRS波为室性逸搏及心室夺获交替出现。卧位(附图下行)房室传导正常。
A rare report of 3-phase paroxysmal atrioventricular block caused by changes in position. Now we have encountered a report as follows. Male patients, 75 years old, 8 years history of hypertension (170/120 high), recurrent syncope for 2 years, nearly 2 months after the activity of chest tightness, shortness of breath, dizziness and other symptoms worse, and more than when standing. Clinical diagnosis of hypertensive heart disease, coronary heart disease. After admission, check the ECG shows sinus rhythm 60 beats / min, left axis deviation -30, complete right bundle branch block, left ventricular hypertrophy. X-ray showed tortuous aortic arch, widened, left heart edge full. Three general laboratory tests, blood glucose, blood lipids are normal. March 29, 1985 after getting up suddenly felt chest tightness, shortness of breath, dizziness, heart rate immediately auscultation about 30-40 beats / min, irregularities, and immediately check the location and supine ECG. Ⅱ position shows a high degree of atrioventricular block, the atrial rate of about 80 beats / min, ventricular relaxation pacemaker rate of about 40 beats / min, the third heart (Figure, the Bank of China, see page 103) Pacing for the ventricular seizure. Standing V_1 lead was 3: 1 atrioventricular conduction, the penultimate QRS wave for ventricular premature beats, in the previous QRS wave of ventricular escape and ventricular seizures alternately. Supine position (with map down) atrioventricular conduction is normal.