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1 病例报告例1:患者男,69岁,因胸骨后持续性压榨性疼痛15小时入院,患者有高血压病史5年,平时服用硝苯地平降压,无糖尿病史.查体:血压150/90 mmHg,心界不大,心率52次/分,未闻及杂音.两肺呼吸音粗,肺底部湿罗音,心电图示窦性心动过缓,电轴左偏(-90),Ⅱ、Ⅲ、AVF、V6-V9呈QS型或QR型,ST段呈弓背向上抬高(0.3～0.8 mv)形成单向曲线,S Ⅲ>SⅡ,V1呈rsR型;STI、aVL、V1-V3压低,T波倒置;Ⅲ度AVB,完全性右束支传导阻滞,左前分支传导阻滞.经静脉内溶栓及抗凝等治疗后,胸痛有所缓解,ST段下降大于50%.4小时后心电图示窦性心律,心率72/分,1度AVB.左前分支传导阻滞,下壁正后壁急性心肌梗死,入院后10小时病人突发呼吸困难,口吐白沫,意识丧失;血压由150/94 mmHg降为60/30 mmHg,心率由窦性70/分转为室性逸搏心律35/分,提示完全性三束支阻滞.床边超声心动图见心包内大量积液,室壁连续性中断.抢救40分钟无效死亡.
A case report, male patient, aged 69, was admitted to hospital with persistent soreness after sternum for 15 hours. The patient had a history of hypertension for 5 years and took nifedipine to depressurise and no history of diabetes. Physical examination: blood pressure 150 / 90 mmHg, heart is not big, heart rate 52 beats / min, no smell and noise.Hair breath sounds thick, wet bottom of the lung rales, ECG showed sinus bradycardia, left axis deviation (-90), Ⅱ, Ⅲ, AVF, V6-V9 were QS type or QR type. The ST segment showed a unidirectional curve with raised arch (0.3-0.8 mv), S Ⅲ> SⅡ and V1 were rsR type. STI, aVL and V1- T wave inversion, Ⅲ degree AVB, complete right bundle branch block, left anterior branch block.After intravenous thrombolysis and anticoagulation therapy, chest pain was relieved, ST segment decreased more than 50% .4 hours later ECG showed sinus rhythm, heart rate 72 / min, 1 degree AVB. Left anterior branch block, the next wall posterior wall acute myocardial infarction, 10 hours after admission, patients with sudden respiratory dysfunction, foaming at the mouth, loss of consciousness; blood pressure by 150/94 mmHg down to 60/30 mmHg, heart rate from sinus 70 / minutes to ventricular escape rhythm 35 / min, suggesting complete three bundle branch block.Each bedside echocardiography see the pleural effusion, Wall continuity interrupted. Rescue 4 0 minutes invalid death.