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男、28岁、教师。既往有阵发性心悸史,1990年5月18日在上课时突然心悸胸闷头晕,4小时后来院就诊.体检:BP12/8kPa,颈静脉无怒张,心率187次/分,心律不齐。心电图示各导联P波消失R—R绝对不齐。心室率180～200次/分,QRS波宽大畸形,V_2至V_5主波向上,其起始部可见△波。心电图诊断C型预激综合征并心房纤颤和心室率过速。既以异搏定10mg加5％葡萄糖20ml静注无效,30分种后用普鲁卡因酰胺200mg加入5％萄萄糖200ml中静点仍无效。在静注安定20mg后,以同步直流电200W/s复律为窦性心律。讨论:预激综合征合并心房纤颤的发生机理系房室间存在异常传导组织,当第一折返激动迅速到
Male, 28 years old, teacher. Past history of paroxysmal heart palpitations, sudden heart palpitations, chest tightness and dizziness in class on May 18, 1990, 4 hours later to hospital for treatment. Physical examination: BP12 / 8kPa, no jugular vein engorgement, heart rate 187 beats / min, arrhythmia. ECG P wave disappearance of the lead R-R is absolutely missing. Ventricular rate of 180 to 200 beats / min, QRS large wave deformity, V_2 to V_5 main wave up, the beginning of visible △ wave. ECG diagnosis of type C pre-excitation syndrome with atrial fibrillation and ventricular tachycardia. Both verapamil 10mg plus 5% glucose 20ml intravenous ineffective, after 30 minutes with procainamide 200mg added 5% glucose 200ml in the static point is still invalid. After intravenous stability 20mg, with synchronous DC 200W / s cardioversion sinus rhythm. Discussion: Wolff-Parkinson-White syndrome associated with the mechanism of atrial fibrillation Department of anomalous conduction exists between the chambers, when the first rebound excited quickly to