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例1,64岁女性,因“活动后胸闷、气短20余年,加重3天”为主诉于2001年12月7日入院,伴夜间憋醒,不能平卧及双下肢浮肿,既往高血压病史30余年,糖尿病史10余年。入院时查体:BP 180/105 mmHg,肥胖体形,半坐位,无颈静脉怒张,口唇轻度紫绀,双肺底可闻及少量水泡音,心界向左侧扩大,心率89次/min,律齐,心尖部可闻及4/6级收缩期吹风样杂音,向心底部传导。余瓣膜听诊区未闻及病理性杂音,肝脾不大,双下肢轻度浮肿。辅助检查:ALT、AST 轻度升高,CK-MB、CK、LDH 正常,BUN、Cr 正常,心电图正常,心脏三位片提示两下肺纹理增多,边界模糊不清,心脏向双侧扩大。多普勒超声见左房、左室增大,室间隔、左室后壁增厚,二尖瓣后叶瓣尖及部分瓣体突入左房侧,前后叶对合错位,关闭有裂隙,提示二尖瓣后叶腱索部分断裂并重度关闭不全。临床诊断高血压病3级(极高危),左心功能不全,二
Example 1,64-year-old woman, because of “post-operative chest tightness, shortness of breath more than 20 years, aggravating three days ” chief complaint on December 7, 2001 admission, with nighttime arousal, can not lie down and edema of both lower extremities, previous high blood pressure More than 30 years of history, history of diabetes more than 10 years. Admission examination: BP 180/105 mmHg, obese body shape, semi-sitting, no jugular vein engorgement, lips mild cyanosis, both lungs can be heard and a small amount of blisters sound, the heart bound to the left to expand, heart rate 89 beats / min , Law Qi, apex can be heard and 4/6 systolic hair-like murmurs, to the bottom of the heart conduction. I valve auscultation area is not known and pathological murmur, liver and spleen is not large, mild swelling of both lower extremities. Auxiliary examination: ALT, AST mildly elevated, CK-MB, CK, LDH normal, BUN, Cr normal, normal electrocardiogram, heart three films prompted two lungs increased texture, the boundary blurred, the heart enlarged to both sides. Doppler ultrasound, see the left atrium, left ventricular enlargement, ventricular septal thickening of the posterior wall of the left ventricle, mitral valve tip and part of the valve body into the left atrial side, anteroposterior and posterior interocclusion dislocation, the closure of the fracture, suggesting Mitral valve posterior lobe chordae part of the fracture and severe incomplete closure. Clinical diagnosis of hypertension 3 (very high risk), left ventricular dysfunction, two