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患者女性,57岁,胸闷、气急、头昏10年,症状加重近半年。自述有心动过速史,发作时心率在100次/分以上。体检:BP110/70,心律齐,A_2亢进,无病理性杂音。心电图(ECG)示窦性心律,心率83次/分,完全性右束支传导阻滞。四天后ECG(图1)示窦性心律,心率65次/分,P-R间期0.01秒,QRS波增宽0.18秒,各导联可见明显δ波(V_1—V_6正向),V_1导联呈R型(R波顶端错折),I、V_5导联见明显增宽S波,据此诊断为WPW(A型)合并RBBB。病员稍活动后ECG(图2)仍示窦性心律,心率75次/分,而QRS波出现两种形态,如V_1导联R_(1、5、6、9、10)和V_5R_(1、2、5、6、9、10)波形与图1 QRS波一致,而V_1导联R_(2、3、4、7、8)和V_5R_(3、4、7、8)波形与门诊ECG一致,表现为P-R间期0.16秒,QRS波时间0.14秒,导联V_1呈rR型,V_5呈R_s型,S波增宽,无δ波。因此确诊为间歇性WPW(A型)合并RBBB。
Female patients, 57 years old, chest tightness, shortness of breath, dizziness 10 years, the symptoms worsened nearly six months. Self-report history of tachycardia, heart attack rate of 100 beats / min or more. Physical examination: BP110 / 70, rhythm Qi, A_2 hyperthyroidism, no pathological noise. Electrocardiogram (ECG) showed sinus rhythm, heart rate 83 beats / min, complete right bundle branch block. Four days later, the ECG (Figure 1) showed a sinus rhythm with a heart rate of 65 beats / min, a PR interval of 0.01s, a QRS broadening of 0.18s, and a clear δ wave (V_1-V_6 positive) in each lead. R type (R wave top of the wrong end), I, V_5 lead was significantly increased S wave, which was diagnosed as WPW (A type) with RBBB. ECG (Figure 2) still showed sinus rhythm, the heart rate was 75 beats / min, while QRS wave appeared two forms, such as V_1 lead R_ (1,5,6,9,10) and V_5R_ (1, 2, 5, 6, 9, 10) waveforms are consistent with the QRS wave of Figure 1, while the V_5R_ (3, 4, 7, 8) , Showing PR interval of 0.16 seconds, QRS wave time of 0.14 seconds, leads V_1 rR type, V_5 was R_s type, S wave broadening, no δ wave. It is therefore diagnosed as intermittent WPW (type A) with RBBB.