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患者男,71岁,3天前饮酒后突发上腹疼痛、向左肩、背放散,伴恶心、呕吐、气短、周身冷汗,持续1小时自行缓解.当地医院按“胃炎”治疗,病人气短渐加重.烦燥,夜不能眠,来我院就诊.查体:急性病容、血压22/12kPa两肺底散在湿罗音、心率68次/分,律齐,心音低钝,A_2>P_2.各瓣膜听诊区未闻及病理性杂音.心电图:P—R 0.28秒,Ⅱ、Ⅲ、avF导联呈QS波,ST弓背型抬高1mV,T波对称倒置.诊断:冠心病、急性下壁心肌梗塞,I度房室传导阻滞(AVB),心功能不全三级.除急性心肌梗塞的一般处理外、给予极化液加硝酸甘油静滴、阿斯匹林120mg/d,潘生丁50mg3次/日口服,当第四次服药(潘生丁总量200mg)后.
Male, 71 years old, 3 days before the sudden onset of upper abdominal pain after drinking, to the left shoulder and back, with nausea and vomiting, shortness of breath, whole body cold sweat, 1 hour self-remission. Local hospital according to “gastritis” treatment, the patient gradually shortness of breath Aggravating. Irritable, the night can not sleep, to our hospital. Physical examination: acute disease, blood pressure 22 / 12kPa two lungs scattered in the end of wet rales, heart rate 68 beats / min, law Qi, heart sounds low blunt, A_2> P_2. Valvular auscultation area is not known and pathological murmur.Electrocardiogram: P-R 0.28 seconds, Ⅱ, Ⅲ, avF lead was QS wave, ST bow backlift type 1mV, T wave symmetrical inversion .Diagnosis: coronary heart disease, acute inferior wall Myocardial infarction, I degree atrioventricular block (AVB), cardiac dysfunction level 3. In addition to the general treatment of acute myocardial infarction, given intravenous infusion of polar fluid plus nitroglycerin, aspirin 120mg / d, dipyridamole 50mg3 Oral daily, when the fourth dose (dipyridamole total 200mg).