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患者 男性,56岁。因反复昏厥2年,再发1个月入院。患者近2年来曾发生3次昏厥,最后一次在1个月前发生。近1个月来反复头晕。体检:T36.3℃,P35次/分,R24次/分,BP16/7kPa,神清,头颅五官无异常,颈静脉无怒张,心界无扩大,心率36次/分,节律不整齐,各心瓣膜区未闻杂音,余无阳性体征。心电图示Ⅲ度房室传导阻滞,心室率为35次/分。诊断:冠心病,心律失常,Ⅲ度房室传导阻滞,心源性昏厥。用盐酸异丙肾上腺素以1.0μg/分的速度静滴后出现心房扑动,停用异丙肾上腺素半小时后转为Ⅲ度房室传导阻滞。几天后,心电监护显示Ⅱ度Ⅱ型房室传导阻滞,呈2:1传导,心室率38～40次/分,再次给予静滴盐酸异丙肾上腺素每分钟1.0μg用药10分钟后又出现心房扑动,心室率为52次/分,间有阵发性室上性心动过速,停用异丙肾上腺素30分钟后转为窦性心律,Ⅱ度
Male patient, 56 years old. Due to repeated fainting 2 years, another 1-month admission. The patient had 3 episodes of fainting in the last 2 years, the last one more than 1 month ago. Nearly a month to dizziness. Physical examination: T36.3 ℃, P35 beats / min, R24 beats / min, BP16 / 7kPa, Shen Qing, no abnormal cranial features, no jugular vein engorgement, no expansion of heart, heart rate 36 beats / min, irregular rhythm, The heart valve area did not smell noise, I no positive signs. ECG third degree atrioventricular block, ventricular rate was 35 beats / min. Diagnosis: Coronary heart disease, arrhythmia, Ⅲ degree atrioventricular block, cardiogenic fainting. Atrial flutter was induced with isoproterenol hydrochloride intravenously at a rate of 1.0 μg / min, and half an hour after stopping isoproterenol to a third degree atrioventricular block. A few days later, ECG monitoring showed type II degree atrioventricular block, with a 2: 1 conduction and a ventricular rate of 38-40 beats / min. Again, an intravenous infusion of 1.0 micrograms of isoprenaline hydrochloride per minute for 10 minutes was given Atrial flutter occurs again, the ventricular rate was 52 beats / min, between paroxysmal supraventricular tachycardia, isoproterenol is stopped after 30 minutes into sinus rhythm, degree II