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患者女性,58岁。有20年的风湿病史,近三年来症状加重,但无栓塞、晕厥及咯血史。平静时体温、脉搏、心律、呼吸及血压正常。体检:颈静脉怒张,心界扩大,心尖区有舒张期震颤,可闻Ⅱ～Ⅲ级舒张期杂音P_2>A_2。双肺底可闻中小水泡音。实验室检查均在正常范围内。X线检查符合二尖瓣狭窄。ECG示Ⅰ°房室传导阻滞,右室肥厚,心电轴右偏+116°。超声心动图示二尖瓣前后叶均增厚,后叶不动,瓣口面积1.05cm~2,未探及心腔内血栓。心导管测得右室压65/10mmHg(平均35mmHg),肺毛细血管压平均
Patient female, 58 years old. A 20-year history of rheumatism, the past three years increased symptoms, but no embolism, fainting and hemoptysis history. Calm body temperature, pulse, heart rate, respiration and normal blood pressure. Physical examination: jugular vein engorgement, heart expansion, apex diastolic diastolic, can be heard Ⅱ ~ Ⅲ diastolic murmur P_2> A_2. Double lungs can be heard in small blisters sound. Laboratory tests are within the normal range. X-ray examination consistent with mitral stenosis. ECG showed Ⅰ ° atrioventricular block, right ventricular hypertrophy, right axis deviation ± 116 °. Echocardiography showed mitral valve thickening before and after the leaves, the posterior lobe does not move, the valve orifice area 1.05cm ~ 2, did not explore and intracardiac thrombus. Cardiac catheterization measured right ventricular pressure 65 / 10mmHg (average 35mmHg), pulmonary capillary pressure mean