论文部分内容阅读
患者,男,75岁,住院号78387,1989年5月3日入院。该患劳累性心前区压榨样痛或闷痛反复发作9年。于1982年患急性前壁及下壁心肌梗塞,后仍有反复心绞痛发作,间隔3—10天发作1次,9天前因“生气”诱发心绞痛频繁发作。每天发作10—15次,舌下含硝酸甘油只能缩短心绞痛发作持续时间,但不能减少发作次数。检查:Bp20/12KPa(150/90mmHg),半坐位,口唇发绀,心左界第五肋间乳线外0.5Cm,心律不齐,偶有室早。心尖区在心绞痛发作时可听到Ⅵ级收缩期吹风样杂音。心绞痛缓解后杂音变为Ⅱ级。阵发性呼吸困难发作时,两肺底可听到水泡音。心电图:陈旧性前间壁及下壁心肌梗塞,慢性冠状动脉供血不足。胸片:左室略增大,超声心动图、左室内径60mm,SEF41mm/s,二尖瓣、室壁搏动幅度减弱。临床诊断:冠心病、陈旧性前间壁、下壁心肌梗塞,劳累性不稳定性心绞痛,左心功能不全。
Patient, male, 75 years old, hospital number 78387, admitted to hospital on May 3, 1989. The suffering from precordial pressure or tenderness pain repeated episodes of 9 years. In 1982 suffering from acute anterior and inferior myocardial infarction, there are still repeated episodes of angina pectoris, an interval of 3-10 days 1 episode, 9 days ago due to “angry” frequent episodes of angina. 10-15 episodes per day, sublingual nitroglycerin can only reduce the duration of angina attacks, but can not reduce the number of attacks. Check: Bp20 / 12KPa (150 / 90mmHg), semi-sitting position, cyanosis of the lips, the heart of the left intercostal intercostal line 0.5Cm, arrhythmia, occasional room early. Apical area in the onset of angina can be heard â ... ¤ grade systolic hair-like murmur. After the relief of angina into a second-level noise. Paroxysmal dyspnea attack, the end of the lungs can hear the sound of blisters. Electrocardiogram: old anterior and inferior wall myocardial infarction, chronic coronary insufficiency. X-ray: left ventricular slightly increased, echocardiography, left ventricular diameter 60mm, SEF41mm / s, mitral valve, ventricular beat amplitude decreased. Clinical diagnosis: coronary heart disease, old anterior wall, inferior wall myocardial infarction, exertion unstable angina, left ventricular dysfunction.