恶化型心绞痛向右上肢牵涉痛1例

患者 ,男 ,66岁。因反复劳力性心前区疼痛 2年 ,频发心前区疼痛 7d入院。患者 2年前开始上 3层楼时出现心前区闷痛 ,每次几十秒至 1 min,休息1 min可缓解 ,每个月发作 1～ 2次。3个月前开始在用力、情绪激动时出现心前区闷痛 ,每次持续 2～ 3min,经休息或含服“速效救心丸”或“消心痛片”3～5min后可缓解 ,每个月发作 3～ 5次。近 1年心前区闷痛频繁发作 ,每日 3～ 5次 ,每次持续 2～ 2 0min,伴冷汗、头昏、乏力 ,同时有整个右上肢酸痛或不适 ,心前区疼痛与右上肢疼痛同时发作、消失 ,有时右上肢疼痛较心前区疼痛先发 1～ 2 min,休息和含服…     

罕见的单支冠状动脉伴发心绞痛1例

患者,男,5 7岁。以反复心前区疼痛3年、加重1d入院。该患者3年来多于劳累时出现心前区闷痛,每次1 0min余,休息或含服硝酸甘油3～5min可缓解,此次因反复再发心前区疼痛,持续2h伴大汗,含服硝酸甘油不缓解入院。患者否认高血压史。入院体检除心率慢( 4 0～45次/min)外,余无阳性体征。心电图示窦性心动过缓,V2～4导联T波深倒置,V5、6T波低平、负正双向。心肌酶学正常。入院后根据典型的心绞痛病史、心电图及心肌酶学,考虑为冠心病、不稳定型心绞痛。经积极的扩管、抗凝、抗血小板聚集、调脂治疗后,很快病情平稳。而后为患者进行了冠状动脉造影…     

粥样硬化性冠状动脉瘤一例

患者,男,61岁.因发作性心前区疼痛15年,加重1月,于1990年3月24日入院.患者于1975年在行走途中突感心前区压榨样闷痛,向左臂及左无名指放射,伴出汗及面色灰白,休息数分钟后缓解.以后每次活动时均出现类似症状,含服硝酸甘油有效。1980年曾有1次心前区剧痛,持续1个多小时,伴以呼吸困难,含服硝酸甘油也不能缓解。1985年首次来我院门诊,心电图诊断为陈旧性前壁心肌梗塞。此后,心前区疼痛不仅发生于活动时,还发生于夜间静卧时,疼痛持续时间延长,硝酸甘油疗效转差。因病情加重而住我院。     

冠状动脉造影正常的左室室壁瘤钙化1例

患者男性,52岁,因“发作性胸痛16年,加重伴心悸10d”入院。患者16年前因胸痛在外院诊断为“急性前壁心肌梗死”,对症处理后症状缓解,间断服用“阿司匹林、消心痛”等药物,活动后间断有心前区疼痛,每次持续3～5min,休息后或含服“硝酸甘油”症状可缓解。10d前,患者饮酒后开始出现心悸症状。自测脉搏不齐,服“心律平”无效入院。     

左冠状动脉前降支闭塞引起一过性巨大U波倒置

男性,60岁。发作性心前区疼痛4d,加重6h,于1998年1月5日入院。缘于1月2日晚17:00劳累后出现心前区压迫样疼痛,伴出汗、心慌,无放射痛,时限约3—5min。休息或含服硝酸甘油后均迅速缓解,并自服复方丹参片治疗。其心前区疼痛,发作约10余次。1月4日23时心前区疼痛再次发作并加重,呈持续性伴     

冠脉痉挛致心绞痛伴晕厥1例

1病历摘要 患者，男，62岁，因反复心前区疼痛伴晕厥1年，复发1天入院。1年前患者出现反复心前区疼痛伴晕厥的症状，症状于活动及休息时均可发生，持续3～5min左右自行缓解。l天前，患者症状再次复发，心前区疼痛时出现晕厥、呼之不应的症状，5min后症状缓解，入我院求治。患者有30年的吸烟史，每日吸烟约20支。     

左心室血栓由左右冠状动脉同时供血1例

患者男性,45岁,因间断胸痛10个月入院.患者于入院前10个月无明显诱因出现心前区疼痛,向背部及左上肢放射,经休息及含服硝酸甘油后症状不能缓解.急送当地医院,诊断为冠心病,急性前壁心肌梗死,经药物治疗后好转出院.此后症状间断发作,含服硝酸甘油能够缓解,为进一步诊治入我院.     

老年复杂冠脉病变合并肾功能不全介入治疗1例

患者男性,69岁,主因发作性心前区疼痛不适1周,加重2d急诊入院。患者于入院前1周活动后突然出现心前区不适,有轻度压迫感,休息后症状逐渐缓解。入院前1d开始反复出现心前区疼痛不适,伴有憋喘,休息后无改善,给予硝酸甘油口服后症状缓解。人院当日早饭后再次突然出现心前区疼痛不适,症状剧烈,伴有呼吸困难、意识模糊,     

主动脉球囊反搏成功抢救高龄老人急性心肌缺血并心源性休克一例

1 临床资料 患者，男，87岁，主因发作性心前区闷痛7年，加重2周，于2006年6月急诊入院，患者于1999年劳累后出现心前区闷痛，无大汗及放射痛，休息或者含服硝酸甘油5mg后10min可以缓解，长期口服扩冠等药物，入院2周前无明显诱因再次出现心前区闷痛，疼痛程度较前加重，伴有出汗，反复含服硝酸甘油片后约20min缓解，体检：神清，血压140／80mmHg（1mmHg=0．133kPa），双肺呼吸音粗，肺底未闻及干湿性啰音，心界不大，心率72次／min，律齐。     

大剂量阿托伐他汀治疗PCI后心绞痛1例

男性，75岁，反复劳累时心前区疼痛3个月。患者于1998年接受经皮冠状动脉介入治疗（PCI），于左前降支和右冠脉内植入支架。最近3个月来经常于活动或拿重物时，出现胸闷、胸痛，经休息或舌下含服硝酸甘油后好转。患者有2型糖尿病、高血压病2级。     

Pulmonary granulomatous lesion with severe chest pain and hemoptysis: a case report]

We encountered a rare case of pulmonary granulomatous lesion accompanied with severe chest pain and hemoptysis. A 42-year-old man visited our hospital complaining of hemosputum. A chest radiograph showed a nodular shadow in the left lower lung field. Further examinations including fiberoptic bronchoscopy, bronchoalveolar lavage and transbronchial lung biopsy did not suggest a diagnosis. During the course of his illness, he suffered an episode of severe chest pain which could be controlled only by intravenous morphine chloride (10 mg). The chest radiograph at the time showed a broad infiltration in the left lower lung field. However, the lung perfusion scintigram taken 2 days before demonstrated decreased blood flow in the same field. We waited for the infiltration in the chest radiograph to diminish and then performed partial resection of the left lower lobe, thus terminating both hemosputum and chest pain. Histological examination showed a cavitary lesion in the periphery of the lung, surrounded by large numbers of infiltrating plasma cells and lymphocytes, among which were many hemosiderinladen macrophages. A small amount of mycelium, considered to be Nocardia or fungus, was seen in the cavity wall. These findings may indicate that an infection had contributed to the formation of a hemorrhagic granulomatous lesion, and that this lesion caused chest pain mainly because of the pleuritis and the decrease in the local pulmonary circulation.     

A case of chest pain variant asthma]

A 45-year-old woman afflicted with bronchial asthma consulted our hospital because of severe constricting pain at the sternal area. Her chest pain improved with montelukast, and she was diagnosed to have chest pain variant asthma. Chest pain variant asthma is rare.     

The acute cor pulmonale: Report of a case occurring eleven days post partum

A case of congenital dextrocardia with situs inversus is presented in which there is good evidence that a previous coronary thrombosis had taken place. The most interesting feature is the distribution of the pain during the attacks of angina pectoris. Before and after the attacks a feeling of numbness appeared in the right arm. The pain was localized strictly to the right side of the chest and there was no radiation to the left arm or neck. When the organs are situated in their normal position the pain is usually localized to the left side of the chest with radiation to the left arm although the pain may sometimes extend to the right chest with radiation to both arms or to the right arm alone. Anatomical evidence shows that the sensory nerve supply from the heart is bilateral and that impulses pass to both sides of the spinal cord. It seems probable however that when the heart is normally situated the main pain pathways run to the left side of the cord while the present case suggests that in dextrocardia they enter on the right side.     

Stuck prosthetic aortic valve resulting in intermittent chest pain and ST depression: a case report

Dysfunction of any mechanical prosthesis due to thrombus or pannus requires prompt definite diagnosis and therapy. A 55-year-old woman had received a prosthetic valve for aortic regurgitation 3 years before and was admitted for intermittent chest pain. Electrocardiography showed remarkable ST depression in broad leads during chest pain. Coronary angiography and cinefluoroscopy performed for definite diagnosis at the time of the third attack revealed no stenotic lesion in the coronary artery, but an artificial valve stuck in the completely open position. The diagnosis was acute aortic regurgitation caused by the stuck open valve. Urgent reoperation was performed. Abnormal proliferation of pannus trapping the artificial aortic valve was found at the left ventricular-side orifice of the prosthetic valve. Intermittent valvular sticking can cause acute aortic regurgitation and caused the symptomatic intermittent chest pain and ST depression in this patient.     

A case of chest pain variant asthma with headache]

A 37-year-old man consulted our hospital because of severe constricting pain at the right side of the chest and head. Since his chest pain and headache improved with inhaled procaterol hydrochloride, chest pain-variant asthma was diagnosed. Not so many articles have been reported that concerned with this disease. There is a need for a better dissemination of knowledge about this disease.     

Mesalamine-induced chest pain: a case report

Cardiac side effects of mesalamine are uncommon. A young man with ulcerative colitis who developed recurrent chest pain and electrocardiographic changes while on mesalamine is presented. Various causes of mesalamine-induced chest pain are discussed.     

Acute chest syndrome as the inaugural sign of sickle cell anemia. A case report and review of the literature

Acute chest syndrome is a frequent complication of sickle cell disease. This syndrome is characterized by recent infiltrate on chest X-ray with chest pain or fever or dyspnea. We report the case of a 26-year-old man in whom an acute chest syndrome with fat embolism was the inaugural sign of sickle cell disease. This report illustrates the frequency of potentially serious fat embolism in the acute chest syndrome and the importance of bronchoscopy and bronchoalveolar lavage (fatty macrophages) for determining the etiology of acute chest syndrome.     

Spontaneous intercostal pulmonary hernia: a case report

In pulmonary hernia or pneumocele the lung protrudes through a defect in the chest wall. In this report of a case of spontaneous intercostal lung hernia, we describe the pathogenesis and classification of such hernias, including signs, symptoms, radiological findings and treatment methods. Our patient presented with severe chest pain at the base of the left hemithorax. A chest film and computed tomography of the region showed an left intercostal hernia. Surgical treatment was successful.     

Deanxit relieves symptoms in a patient with jackhammer esophagus: A case report

Jackhammer(hypercontractile) esophagus presents with dysphagia and chest pain. Current treatments are limited. We describe a 60-year-old man who presented with dysphagia, chest pain and heartburn for a period of 1 year. His workup showed Barrett's esophagus on endoscopy and high-resolution manometry demonstrated jackhammer esophagus with esophagogastric junction outflow obstruction. The patient was treated with proton pump inhibitor and nifedipine but without resolution of his symptoms. He was followed up to assess the efficacy of treatment with deanxit(flupentixol + melitracen). Dysphagia and chest pain resolved during the therapeutic trial and efficacy was maintained on maintenance treatment without troublesome side effects.