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患者男,77岁。阵发性心悸、胸闷、呼吸困难伴间歇性双下肢水肿2年,再发1周入院。有高血压史10余年,体检:BP24/13kPa(180/90mmHg),颈静脉轻度充盈,双下肺呼吸音弱,可闻及少许湿啰音,心界向左扩大,心率77次/min,律齐、心尖区可闻及Ⅱ级收缩期杂音,较局限。膝以下凹陷性水肿。X线胸片示心界向左扩大,轻度肺淤血。心电图示:窦性心律,77次/min。超声心动描记术示:左心室肥厚。血生化正常。临床诊断为原发性高血压Ⅲ期,心衰Ⅲ度。给予5％葡萄糖20ml加米力农5mg静脉注射,然后用5％葡萄糖250ml加米力农5mg静脉滴注。滴注时心电监护(附图)显示窦性心律变为窦房结至房室结内游走节律,心率96次/min。
Male patient, 77 years old. Paroxysmal palpitations, chest tightness, dyspnea with intermittent edema of both lower extremities, re-admitted to hospital for 1 week. Have a history of hypertension more than 10 years, physical examination: BP24 / 13kPa (180 / 90mmHg), jugular vein mild filling, double lower lung breath sounds weak, can be heard and a little wet rales, heart left to expand, heart rate 77 beats / min , Law Qi, apical area can be heard and Ⅱ systolic murmur, more limited. Pitting below the knee edema. X-ray showed the heart left to expand, mild pulmonary congestion. ECG: sinus rhythm, 77 beats / min. Echocardiography showed: Left ventricular hypertrophy. Blood biochemistry normal. Clinical diagnosis of essential hypertension stage Ⅲ, heart failure Ⅲ degree. Give 5% glucose 20ml plus milrinone 5mg intravenous injection, and then use 5% glucose 250ml plus milrinone 5mg intravenous infusion. Instillation of ECG monitoring (with photos) shows that sinus rhythm into the sinoatrial node to atrioventricular node walking rhythm, heart rate 96 beats / min.