急性心肌梗死并发室间隔穿孔1例

患者 ,女 ,64岁。因持续性心前区疼痛 ,气短 1d,于 1 998年 5月 4日入院。患者于入院前 1 d在劳动时突然心前区呈“压榨样”剧痛向左肩背部放射 ,面色苍白 ,大汗淋漓 ,气短 ,经休息后不能缓解 ,在当地乡卫生院求治 (具体用药不祥 )仍无好转而来我院。入院体检 :T37℃ ,P1 0 6次 /min,R2 8次 /min,BP90 /75mm Hg( 1 mm Hg=0 .1 33k Pa) ,半卧位 ,皮肤湿冷 ,眼睛黑目蒙 ,面色青灰 ,口唇紫绀 ,颈静脉怒张 ,双肺底可闻及细湿口罗音 ,胸骨左缘第 3、4肋间可触及收缩期震颤 ,心界向两侧扩大 ,心率 1 0 6次 /min,律齐 ,胸骨左缘第 3、4肋间可闻…     

老年重症心肌炎和心包炎及胸膜炎一例

<正>1临床资料患者女,69岁。因"发热、咳嗽伴乏力、胸闷4 d"于2009年9月20日入院。患者于入院前4d感冒,体温39.5℃,伴胸闷、咳嗽、咳白色黏痰。高血压10余年,血压最高180/110 mm Hg(1 mm Hg=0.133 kPa),口服替米沙坦80mg/d。查体:体温37.6℃,血压87/62 mm Hg,心率108/min,呼吸20/min。心左界于左锁骨中线第五肋间,心律齐,     

房间隔缺损伴左上肺静脉畸形引流二例

例1 患者男性,15岁,发现心脏杂音1周.血压:100/60mmHg(1 mm Hg=0.133 kPa),心率80次/min.胸骨左缘3～4肋间可闻及2/6级收缩期杂音,向颈部及心尖部传导.心电图:完全右束支传导阻滞.     

成人双腔右心室合并肌部室间隔缺损一例

正1临床资料27岁男性患者,发现肌部室间隔缺损(室缺)1个月入院。查体:心率72次/min,血压120/71mm Hg(1mm Hg=0.133k Pa),无紫绀,胸骨左缘第3～4肋间5/6级的收缩期喷射样杂音。心电图示窦性心率,CT示:室间隔肌部室缺。     

伴有严重左室肥厚的急性病毒性心肌炎1例

患者 ,男 ,1 2岁。因发作性心慌、胸闷 3d,加重1 d入院。入院前 50 d患者曾连续 2 0 d出现腹泻伴有低热 (体温 37.5℃左右 ) ,自服黄连素、先锋霉素及退热药后好转。既往曾有短暂“哮喘”发作史两次。入院体检 :体温 37.4℃ ,脉搏 1 0 5次 / min,呼吸1 6次 / min,血压 86.5/ 52 .6mm Hg( 1 mm Hg=0 .1 33k Pa) ,发育及营养状况一般 ,精神状态好 ,口唇无紫绀 ,颈静脉无怒张 ,双肺未见异常 ,心尖搏动在左锁骨中线第 5肋间 ,未触及心尖抬举性搏动 ,心脏浊音界不扩大 ,心音低钝 ,心率 1 0 5次 / min,心律齐 ,二、三尖瓣听诊区可闻及 II级收缩…     

右冠状动脉-左心室瘘合并巨大右冠状动脉瘤诊治一例

正1临床资料患者,男性,40岁。因"体检发现心脏杂音30年,活动后气促1年"入院。查体:血压130/60 mm Hg(1 mm Hg=0.133 k Pa),心前区可见抬举性搏动,心界叩诊向左下扩大,心率76次/min,律齐,胸骨左缘第2、3肋间可闻及舒张期杂音。心电图示:窦性心律,左心室肥厚伴ST-T改变。超声心动图示(图1):左心室射血分数50%,全心扩大,左心室为主(左心室舒张末期     

心肌淀粉样变性1例

正1 临床资料患者,女,73岁,主因"活动后乏力伴呼吸困难5年,加重3 h"入院。入院查体:心率75次/min,呼吸35次/min,血压80/54 mm Hg(1 mm Hg=0.133 kPa),神志清楚,精神差,面色苍白,口唇发绀,无颈静脉怒张,呼吸急促,双肺呼吸音清,未闻及干湿性啰音,心尖搏动位于左锁骨中线上第五肋间,心界向左扩大,律齐,未闻及明显杂音,四肢湿冷,双下肢水肿。既往史:既往有阵发性心房颤动、原发性甲状腺旁腺功能亢进     

超滑导丝硅胶断裂残留肺动脉一例

患者女性,18岁.因胸痛40 d入院.查体:血压104/59mm Hg(1 mm Hg=0.133 kPa).口唇及四肢末梢无紫绀,发育尚可,双肺未闻及干湿啰音.心前区无隆起,未见异常搏动,心尖搏动位于第5肋间左锁骨中线外O.5 em,搏动无弥散,可及震颤.心前区浊音界向左扩大,心率90次/min,心律齐,胸骨左缘第2～3肋可闻及3/6级连续性机器样杂音.肝脾未触及,桡动脉处可触及水冲脉、股动脉可闻及枪击音.     

动脉导管假性动脉瘤合并主动脉缩窄1例

正1病例资料患者,女,19岁,活动后乏力5年入院。患者5年前剧烈运动时突感胸闷,伴脸色苍白,经保守治疗后一般体力活动仍乏力,无晕厥、呼吸困难。精神、食欲、二便正常。门诊拟诊"先天性心脏病动脉导管未闭"收入院。入院查体:体质量42 kg,身高148 cm,营养较差,左上肢血压130/80 mm Hg(1 mm Hg=0.133 k Pa),左下肢血压102/60 mm Hg,胸骨左缘2、3肋间可触及震颤,闻及4/6级连续性机械样杂音,足     

动脉导管未闭出现广泛巨大倒置T波1例

患者 ,女 ,48岁。因劳力性气促 1 0年 ,情绪激动后呼吸困难 3h于 1 997年 4月 7日入院。体检 :神清 ,呼吸 2 6次 /min,脉搏 1 2 0次 /min,血压 1 1 0 /50mm Hg(1 mm Hg=0 .1 33k Pa) ,端坐位 ,口唇发绀 ,两肺布满湿音 ,心尖向左下移位 ,心浊音界向双侧扩大 ,心尖触诊无震颤 ,心率 1 2 0次 /min,律齐 ,心尖区闻及舒张早期奔马律、胸骨左缘第 2肋间闻及连续性机器样杂音 ,肝脾肋下未扪及 ,双下肢无水肿。血清钾、钠、氯、钙、血糖、肝、肾功能 ,心肌酶均正常 ,胸片提示 :双心室扩大 ,以左心明显 ,心胸比 0 .68,肺水肿。心电图示窦性心律 ,…     

Superior vena cava bypass

A case of superior vena cava obstruction due to carcinoma of unknown origin is reported. A superior vena cava bypass with polytetrafluoroethylene was performed by suturing the prosthesis to the left innominate vein and the right atrium, respectively. Long-term satisfactory results were achieved.     

Bilateral superior vena cava with right superior vena cava draining into left atrium

Anomalies of systemic venous return are extremely heterogeneous congenital malformations with variable ranges from completely normal physiology to severe forms of right to left shunting requiring surgical treatment. Anomalous drainage of a right-sided superior vena cava (SVC) to the left atrium (LA) is one of the rarest variants of systemic venous return anomalies, characterized by right-to-left shunt physiology and cyanosis. Here we report a 2 years old girl presented with cyanosis which was observed shortly after birth by her parents but not further investigated. She is otherwise active girl and with normal growth and development. Her clinical examination was unremarkable apart from mild clubbing of the fingers and low oxygen saturation of 88–90% in room air. Her ECG and chest X-ray were unremarkable. Echocardiography showed bilateral SVC connected by a small innominate vein. The right SVC drains directly into the LA while the left SVC drains into the right atrium (RA) via a dilated coronary sinus. There is a small superior sinus venosus type atrial septum defect (ASD) with left to right shunt. Also, there is partial anomalous pulmonary venous return with right upper and right middle pulmonary veins draining directly into the right SVC, which is connected to LA. The right lower pulmonary vein and left pulmonary veins drain directly to LA. The rest of her echocardiography demonstrated normal heart structures and function. This patient was referred for surgical correction, including baffling of the right SVC to the RA and closure of the ASD. We describe this case to highlight the importance of recognizing this rare anomalous systemic venous connection as one of the very rare causes of cyanosis in the pediatric age group as well as at older age.