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患者,男,65岁。因胸闷、心悸7年,活动后加重伴夜间阵发性呼吸困难3年,不能平卧2个月,于1987年10月30日入院。否认有房颤及其它心律失常史。查体:T 36.5℃,P100次,R20次,BP142/70。半卧位,呼吸稍促,口唇无紫绀,颈静脉怒张明显。HR 100次,律齐。腹软、肝肋下6 cm,剑下8cm,质软、边钝、肝颈逆流(+)。双下肢轻度凹陷性浮肿。FCG示窦性心律,下壁心肌缺血样改变(见图1),诊断为冠心病,全心衰Ⅲ°(左心衰为主),心功能Ⅳ级。入院后多次ECG同上,血钾3.8mmol/L,用地高辛0.25mg qd等药治疗,疗效不显,于1987年11月1日加用多巴酚丁胺,以3.5μg/min滴入,2天后心衰症状消失。11月6日停用多巴酚丁胺,继用地高辛等药;至11月18日听诊发现房颤节律,ECG提示房颤伴Ⅱ°房室传导阻滞(见图2),停地高辛,测血钾4.0mmol/L。两天后心律又复规则,ECG示为窦性心律。1988年2月20日。患者因劳累受凉又出现心衰,服用地高辛,再次出现房颤伴Ⅱ°房室传导阻滞,停用地高辛2天后又转复窦律。
Patient, male, 65 years old. Due to chest tightness, palpitations 7 years, aggravating activity with nocturnal paroxysmal dyspnea 3 years, can not supine for 2 months, on October 30, 1987 admission. Denied a history of atrial fibrillation and other arrhythmias. Physical examination: T 36.5 ℃, P100 times, R20 times, BP142 / 70. Semi-recumbent position, breathing a little faster, no cyanotic lips, jugular vein engorgement obvious. HR 100 times, law Qi. Abdomen soft, liver ribs 6 cm, 8cm under the sword, soft, blunt, liver neck reflux (+). Slightly depressed lower extremity edema. FCG showed sinus rhythm, inferior myocardial ischemia-like changes (see Figure 1), diagnosis of coronary heart disease, full heart failure Ⅲ ° (left heart failure), cardiac function Ⅳ level. Several times after admission ECG as above, potassium 3.8mmol / L, with digoxin 0.25mg qd and other drugs, the effect is not significant, in November 1, 1987 plus dobutamine, 3.5μg / min infusion , 2 days after the heart failure symptoms disappear. November 6 to disable dobutamine, followed by digoxin and other drugs; until November 18 auscultation found atrial fibrillation rhythm, ECG tips atrial fibrillation with Ⅱ ° atrioventricular block (see Figure 2), stop Digoxin, potassium test 4.0mmol / L. Two days later, the rhythm and complex rules, ECG showed sinus rhythm. February 20, 1988 Patients with heart failure due to fatigue and cold, take digoxin, and again with atrial fibrillation Ⅱ ° atrioventricular block, disable digoxin after 2 days and sinus rhythm.