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患者,男性,75岁。12年前患下璧心肌梗塞,之后有窦性心动过缓,心室率42次。5年来发生心房纤颤,心室率70±次,自觉活动后气喘。入院前1月未服用洋地黄。入院前4小时突然心悸、胸闷,无心前区疼痛,无晕厥。体检:神清、平卧,轻度紫绀。血压90/60,脉搏160次,体温35.6℃。颈静脉充盈。心脏显著向左下扩大,心尖搏动在第六肋间锁骨中线外2.5cm。心尖部Ⅲ级收缩期吹风样杂音。双肺下部少量湿性罗音。腹软,肝肋下1.5cm,脾未触及。双下肢不肿。化验检查:血、尿、便常规正常。血清钾、钠、氯;SGOT、CPK、LDH均在正常范围。X线平片示心影显著扩大,主动脉结明显,左心房、左右心室扩大。心电图示宽QRS波群心动过速,以室性心动过速可能性大,不能完全除外预激综合征伴心房纤颤,心室率174次(图1)。
Patient, male, 75 years old. 12 years ago suffering from Bi myocardial infarction, followed by sinus bradycardia, ventricular rate 42 times. Atrial fibrillation occurred in 5 years, ventricular rate 70 ± times, asthma after conscious activity. January did not take digitalis before admission. 4 hours before admission, sudden heart palpitations, chest tightness, no pain in the anterior heart area, no syncope. Physical examination: God clear, supine, mild cyanosis. Blood pressure 90/60, pulse 160 times, body temperature 35.6 ℃. Jugular vein filling. The heart significantly expanded to the left, apical beating in the sixth intercostal clavicle midline 2.5cm. Apical grade Ⅲ systolic hair-like murmur. A small amount of wet rales in the lower part of the lungs. Abdomen soft, liver ribs 1.5cm, spleen not touched. Double lower extremity is not swollen. Laboratory tests: blood, urine, they are normal. Serum potassium, sodium, chlorine; SGOT, CPK, LDH are in the normal range. X-ray showed significantly enlarged heart shadow, aortic node obvious, left atrium, left ventricular enlargement. ECG wide QRS complex tachycardia, the possibility of ventricular tachycardia, can not be completely except for the WPW syndrome with atrial fibrillation, ventricular rate 174 (Figure 1).