心绞痛时心电图呈单纯性T波电交替1例

患者女,58岁。因阵发性前胸压榨性疼痛月余,近日逐渐加重而入院。疼痛可放射至心前区与左上肢,每次持续10min左右,常定时发作,有明显周期性,无明显诱因,使用硝酸酯制剂效果不佳,休息不能缓解疼痛。体检:BP20/12kPa(150/90mmHg),心界不大,心率60次/min,律齐,未闻及病理性杂音,两肺无殊。无心绞痛时心电图为:窦性心律,心率60次/min,Ⅱ、Ⅲ、aVF导联T波低平,V_1—V_3导联T波倒置,V_4一V_6导联T波约为R/10。临床诊断:冠心病,心绞痛。住院期间静息时心电图均呈上述改变。心绞痛发作时心电图表现为:窦性心律,心率65次/min,V_1—V_6导联T波同静息时,Ⅱ、Ⅲ、aVF导联(附图)T波有低平和倒置两种状态,呈有规律的单纯性T波3:1电交替状态。心绞痛停止约10min后描记心电图,又恢复静息时状态。住院期间共记录到3次心绞痛发作时及发作后的心电图变化,均如上述改变。     

变异型心绞痛早期室性早搏ST段异常抬高一例

患者男性,60岁。因间歇性胸部闷痛2个月,频繁发作2天,于1998年1月20日入院。体检心率68次/min,呼吸19次/min,血压135/75 mm Hg(1 mm Hg=0.133 kPa)。腹软,肝、脾未触及。心电图、心向量图示左前分支阻滞。心室晚电位检查阴性。血清电解质、血脂、血糖均正常。入院后,患者胸骨后闷痛发作1-2次/d,均发生在休息或凌晨。图1为监护导联心电检测记录到的典型心绞痛发作时早期室性早搏ST段异常提高的心电图。     

变异性心绞痛发作时ST段抬高伴窦性停搏1例

患者,女性,43岁.因反复胸痛2个月,黑矇2次人院.患者2个月前无明显诱因发作性胸痛,以心前区为主,有时向背部放射,呈阵发性针刺样疼痛,持续约几秒至3分钟不等,可自行缓解,休息及活动均有发作,3～8d发作1次,未介意.近1月患者自觉疼痛发作次数增加,胸痛程度加重.当地医院就诊,多次静态心电图提示:正常心电图.超声心动图提示:左室顺应性下降.入院后行12导联动态心电图(12-AECG)检查,第2天早上6:53休息时发作心前区疼痛,约10 min自行缓解.回放12-AECG发现,心绞痛发作前约1 min(图1)示:心率90次/min,P-R间期0.12s,QRS波群形态、时间正常,ST段在Ⅲ、aVF导联呈水平型压低0.05 ～0.075 mV,T波无异常;发作时(图1)示:心率65次/min,P-R间期0.12 s,QRS波群形态、时间正常,第2个心搏为房性期前收缩,ST段在Ⅰ、Ⅱ、aVL、aVF、V1～ V3导联呈弓背型抬高0.15 ～0.9 mV;发作后2 min(图1)示:心率53次/min,P-R间期0.12s,QRS波群形态、时间正常,ST段在V1～V3导联呈弓背型抬高0.1 ～0.4 mV,其余ST段回落至基线.     

变异型心绞痛合并急性损伤阻滞二例

急性心肌梗死早期可出现急性损伤阻滞 ,但变异型心绞痛合并急性损伤阻滞尚少有报道。现将临床工作中遇到的 2例报告如下。例 1　患者女性 ,69岁 ,以阵发性胸骨后紧缩感反复发作1个月 ,加重 5d入院。近 5d每天发作 5～ 6次 ,多在下午休息时发作 ,持续 5～ 1 0min可自行缓解。体格检查血压 1 4 0 /90mmHg(1mmHg =0 1 33kPa) ,心界不大 ,心率 90次 /min,心律齐 ,心脏各瓣膜区未闻及杂音。入院心电图正常 (图 1A) ,V2 、V3导联呈RS型 ,V4 、V5导联呈Rs型 ,V6 导联呈qR型 ,QRS时限 0 0 8s。但在记录电极尚未取下时 ,病人出现胸骨后紧缩…     

致心律失常性右心室心肌病并右心室造影1例

资料与方法　　患者女 ,35岁。以反复心悸 2年加重 1个月为主诉入院。曾因有偷停感于当地做心电图。动态心电图频发室早 ,未系统治疗。近 1个月发作 3次心悸 ,呈突发骤止 ,每次持续 3～ 5min可自行缓解 ,最长一次持续 2h缓解 ,当地心电图疑诊室上性心动过速为进一步行介入治疗来我院。查体 :血压110 / 80mmHg ,脉搏 80次 /min ,呼吸 16次 /min ,双肺呼吸音正常 ,心界不大 ,心率 80次 /min ,律齐 ,未闻及杂音 ,双下肢无浮肿。入院时心电图正常 ,发作时心电图示宽QRS波心动过速 ,心率 2 0 0次 /min ,超声心动图示各房室不大 ,心功能正常。择…     

Brugada 综合征一例

临床资料 患者男性,38岁,因反复晕厥9个月于2001年6月27日入院。发作前无明显诱因,晕厥时伴抽搐,持续数秒至5min不等,能自行缓解,数天至数周发作1次,平素无胸闷、胸痛等不适。期间在广州某医院住院时发作过1次晕厥,当时心电监护示心室颤动（图1）,经心肺复苏等抢救,恢复为窦性心律。家族史:其父有多次晕厥史,于67岁猝死,其弟于27岁猝死。体格检查:体温36.7℃,呼吸20次/min,血压100/70mmHg（1 mmHg=0.133kPa）,双肺及腹部无异常,心率100次/min,心律齐,无杂音,化验血、尿、大便常规、肝肾功能、血糖、心肌酶谱、电解质均正常,X线心脏片、彩色超声心动图未见异常。心电图（图2）:图2为入院第1d的心电图,即晕厥发作后第2d的心电图,示窦性心律,V1～V3ST段下斜型抬高,T波倒置,QRS波呈rsd’,酷似完全性右束支阻滞,QT间期正常。患者入院后未经治疗,亦无晕厥发作。结合临床表现及家族史诊断为Brugada综合征。     

血液粘度增高与3相左束支传导阻滞1例

患者男性，44岁。因快速行走后心悸、气短伴心前区隐痛2月入院。发作时含服硝酸甘油及心痛定无效，休息1-2min症状可缓解。临床诊断：冠心病？入院体检：BP120／75mmHg。心界不大，HR78次／min，心律齐，未闻杂音。静息心电图（图1A）正常。运动后出现上述症状，即刻运动心电图（图1B）示，心率达120次／min，并呈完全性左束支传导阻滞，持续5min消失。     

房性心动过速导致Niagara瀑布样T波1例

患者女性 ,6 2岁。以阵发性心慌 3年 ,近 1年加重伴心前区疼痛 1d入院。既往有阵发性心慌 ,无突发、突止现象 ,持续数分钟或数十分钟可自行缓解。近 1年来症状发作频繁伴心前区疼痛。入院体检 :T 36 .4℃ ,P 6 0次 /min ,R 2 4次 /min ,BP14 0 / 10 0mmHg ,双肺无罗音 ,心界无扩大 ,心率 6 0次 /min ,律齐 ,无杂音 ,心肌酶检查正常。心电图 :窦性心律 ,V3～V6 ST下降 0 .0 5mV ,Q T间期 4 0 0ms。入院当日晚 8点 ,患者突然心慌 ,数分钟后胸痛。查血压 180 / 130mmHg ,心率 15 0次 /min ,律齐 ,心电图显示 (图A) :房性心动过速 ,心率 1…     

病例68:52岁男性晨间胸痛

52岁,男性。6周来胸骨下方痛放射到下颌和左上肢,15～30min/次,发作时并没有活动,都是在晨间床上睡觉时,因疼痛惊醒,惟一的危险因素是吸烟。体检:脉搏80次/min;血压:124/84mm Hg,心脏正常。实验室检查:血常规、尿常规、电解质、心肌酶正常,无胸痛时心电图正常。住院经过:入院后第1天3:00AM发作胸痛,当时做心电图如图1,含服硝酸甘油后,胸痛消失,心电图恢复正常。问:病人胸痛原因?如何治疗?何秉贤(新疆医科大学一附院心内科,新疆乌鲁木齐830054)我认为这是一例典型的变异型心绞痛(variantangina)。美国医生Myron Prinzmetal(1908-1994)在195…     

以咽喉部紧缩感表现的老年变异性心绞痛1例报告

1病例男,78岁。间断发作咽喉部紧缩感伴大汗3年,复发加重3h入院。既往无高血压史,抽烟60年,心电图为完全性右束支传导阻滞。近3年患者间断在午夜或凌晨出现咽喉部紧缩感伴大汗,含硝酸甘油可在10min内缓解。因均在院外发病,心电图均无缺血性改变,次极量平板运动图1心绞痛发作时2     

"Abnormal" neurologic findings in the "healthy" elderly

Neuropathological changes and clinical neurological findings of the nervous system of healthy, old people (more than 80 years old) are referenced according to the literature. In addition, the results of a clinical neurological examination of 86 healthy senior citizens (average age: 83.6 years) are demonstrated. The respective findings are summarized in a table according to their frequency. The involution of the human nervous system with age results neuropathologically and clinically-neurologically in damage to the frontal lobe (disinhibition of archaic reflexes), the extrapyramidal system (Parkinsonian walking pattern), the posterior tract of the spine (unsteadiness of walking), and the peripheral nervous system (e.g. loss of the achilles tendon reflex). The Parkinsonian-like walking pattern of the healthy old-aged human is thought to be a disinhibition of an archaic pattern of posture and movement. Brief suggestions for differential diagnosis and therapy are presented.     

"What" and "where" in the human auditory system

The extent to which sound identification and sound localization depend on specialized auditory pathways was examined by using functional magnetic resonance imaging and event-related brain potentials. Participants performed an S1-S2 match-to-sample task in which S1 differed from S2 in its pitch and/or location. In the pitch task, participants indicated whether S2 was lower, identical, or higher in pitch than S1. In the location task, participants were asked to localize S2 relative to S1 (i.e., leftward, same, or rightward). Relative to location, pitch processing generated greater activation in auditory cortex and the inferior frontal gyrus. Conversely, identifying the location of S2 relative to S1 generated greater activation in posterior temporal cortex, parietal cortex, and the superior frontal sulcus. Differential task-related effects on event-related brain potentials (ERPs) were seen in anterior and posterior brain regions beginning at 300 ms poststimulus and lasting for several hundred milliseconds. The converging evidence from two independent measurements of dissociable brain activity during identification and localization of identical stimuli provides strong support for specialized auditory streams in the human brain. These findings are analogous to the "what" and "where" segregation of visual information processing, and suggest that a similar functional organization exists for processing information from the auditory modality.     

Task-modulated "what" and "where" pathways in human auditory cortex

Human neuroimaging studies suggest that localization and identification of relevant auditory objects are accomplished via parallel parietal-to-lateral-prefrontal "where" and anterior-temporal-to-inferior-frontal "what" pathways, respectively. Using combined hemodynamic (functional MRI) and electromagnetic (magnetoencephalography) measurements, we investigated whether such dual pathways exist already in the human nonprimary auditory cortex, as suggested by animal models, and whether selective attention facilitates sound localization and identification by modulating these pathways in a feature-specific fashion. We found a double dissociation in response adaptation to sound pairs with phonetic vs. spatial sound changes, demonstrating that the human nonprimary auditory cortex indeed processes speech-sound identity and location in parallel anterior "what" (in anterolateral Heschl's gyrus, anterior superior temporal gyrus, and posterior planum polare) and posterior "where" (in planum temporale and posterior superior temporal gyrus) pathways as early as approximately 70-150 ms from stimulus onset. Our data further show that the "where" pathway is activated approximately 30 ms earlier than the "what" pathway, possibly enabling the brain to use top-down spatial information in auditory object perception. Notably, selectively attending to phonetic content modulated response adaptation in the "what" pathway, whereas attending to sound location produced analogous effects in the "where" pathway. This finding suggests that selective-attention effects are feature-specific in the human nonprimary auditory cortex and that they arise from enhanced tuning of receptive fields of task-relevant neuronal populations.     

Cytochemical "normal" and "abnormal" eosinophils in acute leukemias.

Eosinophilic leukocytes may accompany a great variety of disorders and different types of acute leukemias. The most striking morphologic feature of eosinophils is their specific granules, but morphology alone often is insufficient to differentiate normal from abnormal eosinophils. Cytochemically, the eosinophils were considered "normal" when they did not contain alkaline phosphatase, chloroacetate esterase, toluidine blue metachromasia, Astra blue positivity, and specific PAS-positive granules, but did have peroxidase and cyanide-resistant peroxidase activities, Sudan black positivity and moderate naphthol-AS esterase or alpha-naphthyl esterase and acid phosphatase positivities. In seven cases of acute leukemias (two acute myeloblastic and five myelomonocytic), in contrast with their normal behaviour, the eosinophils show "abnormal" cytochemical positivities consisting of chloroesterase activity, PAS and Astra blue positivities of the specific granules, toluidine blue metachromasia, and cyanide-resistant peroxidase of a few specific granules. Cytochemical investigations may provide additional criteria for evaluating the abnormality of the eosinophilic cell in leukemias.