腺苷三磷酸终止无休止性右室心尖部特发性室性心动过速一例

患者男 ,2 4岁 ,近 7年常在活动时感阵发性心悸、心率加快 ,休息后缓解。 11个月前因运动及饮酒后心悸加重而就医 ,心电图为宽ＱＲＳ心动过速 ,频率 2 14次 /ｍｉｎ ,呈室房分离。患者心动过速持续发作数小时 ,除血压偏低外无其他血流动力学障碍。超声心动图示左室舒张末期内径 5 9ｍｍ、左房内径 36ｍｍ ,患者无其他器质性心脏病依据 ,考虑为特发性室性心动过速 (室速 )合并心动过速性心肌病。经静脉注射 (静注 )利多卡因、普罗帕酮、维拉帕米、艾司洛尔、美西律、普鲁卡因酰胺 ,口服胺碘酮、美托洛尔及电复律均不能终止室速 ;静注艾司洛尔…     

不稳定型心绞痛ST段"墓碑形"改变1例

患者男性 ,５６岁。因发作性胸骨后压榨性疼痛１周 ,加重３ｈ就诊 ,疼痛时间持续半ｈ伴大汗心悸。既往无原发性高血压及心脏病史。嗜烟３０余年。体检 :急性痛苦病容 ,ＢＰ１２６／８６ｍｍＨｇ,心率９０次／ｍｉｎ ,心律齐 ,未闻病理性杂音。入院时心电图 (图１Ａ)示 :窦性心律 ,Ｖ１～Ｖ４ Ｔ波呈正负双相。７ｍｉｎ后(图１Ｂ)Ｖ１～Ｖ３ＳＴ段抬高０．１～０．３ｍＶ ,Ⅱ、Ⅲ、ａＶＦＳＴ段呈水平型或下斜型压低０．１～０．２ｍＶ ,Ｖ１～Ｖ４Ｔ波直立 ,Ｖ２ ＱＲＳ电压变小。再１１ｍｉｎ后 (图１Ｃ)Ｖ２ ＳＴ段向上凸起并快速上升高达…     

心脏肿瘤致持续性室性心动过速一例

患者男性,26岁,因阵发性心悸8年,加重4天入院。患者于8年前出现阵发性心悸,多次在当地医院就诊,心电图示室性心动过速(室速),ＱＲＳ波群形态呈左束支阻滞,电轴左偏(图1),静脉注射普罗帕酮可终止。室速发作时心率在180～1890次/ｍｉｎ左右,曾出现晕厥一次及因心动过速不终止两次电转复。曾服用过多种抗心律失常药物,效果不佳,仍有室速发作。入院前4天发作室速,静脉注射普罗帕酮可终止,但仍反复发作,遂转入我院继续诊治。入院后给予胺碘酮600ｍｇ/ｄ及美托洛尔50ｍｇ/ｄ,室速发作次数逐渐减少,发作时频率降低,但每日仍有室速发作。入院查体,血…     

预激综合征合并心室颤动2例分析

例１患者男性 ,２８岁。因心悸、胸闷１０余年 ,加重３天入院。体检 :Ｐ９８次／ｍｉｎ ,ＢＰ１７／９ｋＰａ(１２８／６８ｍｍＨｇ) ,心界向左下扩大。彩色超声心动描记术示先天性心脏病 ,二尖瓣狭窄。心电图 (图１上 )示 ,电轴左偏 -１０°,ＲＶ５３．８ｍＶ ,Ｐ＿Ｐ间期均齐 ,频率９６次／ｍｉｎ ,ＱＲＳ时间０．１１ｓ ,Ｖ１～Ｖ５ 导联ＱＲＳ波群均呈Ｒ型 ,起始部可见δ波 ,ＳＴ＿Ｔ呈继发性改变。心电图诊断 :窦性心律 ,Ａ型预激综合征 ,左心室肥大。入院后心悸、气促反复发作 ,发作持续时间逐渐延长、间歇时间越来越短。心电图 (图１…     

变异型心绞痛ST—T电交替现象1例

患者男性 ,５６岁。因心前区闷痛不适２年 ,加重１周入院。疼痛常于午夜发作 ,但１周来从事一般体力活动及休息时均有发作 ,每次持续５～１０ｍｉｎ ,含服硝酸酯制剂可缓解。体检 :ＢＰ１７．２／１０．６ｋＰａ(１３０／８０ｍｍＨｇ)。心界不大 ,心率８８次／ｍｉｎ ,心律齐 ,未闻及病理性杂音。两肺无殊。以往及住院后常规心电图检查均大致正常。入院后动态心电图检查示午夜００∶１５、０２∶３５、０４∶４５、０６∶３３ＭａＶＦ导联ＳＴ段呈弓背型抬高 ,抬高程度０．２～０．５ｍＶ不等 ,反复发作共４次 ,每次发作２～３ｍｉｎ不等 ,…     

VVI起搏频率过缓致阿—斯综合征发作1例

患者女性 ,５３岁。因阵发性晕厥４年 ,再发１ｈ住院。临床诊断 :病态窦房结综合征。患者曾作心电图检查 ,示窦性心动过缓 ,心率４８次／ｍｉｎ。２４ｈ动态心电图示总心率５６２３８次 ,最慢心率３４次／ｍｉｎ ,６次窦性停搏 ,最长Ｒ＿Ｒ间期４．２ｓ。Ｘ线胸片、超声心动描记术及实验室检查未发现器质性心脏病。于４月前置入永久型ＶＶＩ起搏器 ,起搏频率５５次／ｍｉｎ ,随访起搏器感知功能良好 ,无不适。本次入院前１ｈ患者看电视时突感心悸 ,随即意识不清、四肢抽搐、小便失禁 ,约１ｍｉｎ后神志恢复 ,遂急诊入院。体检 :ＢＰ１６／１…     

急性乌头碱中毒致心律失常二例

例１ 患者男性,６０岁。因突发恶心、呕吐、心悸、继而晕厥急诊入院。入院前４ｈ服用川乌药酒约 ３０ｍｌ,２０ｍｉｎ后出现口舌及四肢麻木、恶心、呕吐胃内容物４次,感心悸,入院前１ｈ出现面色苍白,大汗淋漓,进而晕厥。入院时血压 ６０／４５ｍｍＨｇ（１ｍｍ Ｈｇ＝０．１３３ ｋＰａ）,心率 １７０次／ｍｉｎ,心律不齐,急查电解质及血糖均正常,心电监护示反复多形室性心动过速（室速）。临床诊断为急性乌头碱中毒。入院后立即吸氧,补充血容量,阿托品１ｍｇ静脉注射,间隔１ｈ１次,共６次,出现阿托品化后改为间隔６ｈ１次,…     

92岁急性大面积心肌梗死患者抢救成功一例

１ 临床资料 患者男性，９２岁，因突发心前区疼痛２小时于２０００年９月１１日入院。既往体健。入院查体：血压９０／５０　ｍｍＨｇ（１　ｍｍＨｇ＝０.１３３ ｋＰａ），口唇发绀，呼吸略促，颈静脉充盈，双肺可闻及湿音，心率１０４次／分，律齐，无杂音，心音弱，腹（-），双下肢不水肿。入院心电图示：广泛前壁、高侧壁ＳＴ段抬高呈弓背向上，Ｖ１～５导联有Ｑ波形成。伴有短阵室性心动过速（室速）。诊断：冠心病，急性广泛前壁、高侧壁心肌梗死、心功能Ⅲ级（Ｋｉｌｌｉｐｓ），心律失常、频发室性早搏、短阵室速。立即吸氧、吗…     

分支型特发性室性心动过速伴室房1∶1传导1例

患者男性 ,４８岁。因反复心悸、胸闷１０余年 ,加重２个月于１９９９年５月３０日入院。平时心电图正常。体检 :ＢＰ１６．０／１０．７ｋＰａ(１２０／８０ｍｍＨｇ) ,颈静脉无充盈 ,两肺未闻及音。心界不大 ,心率７０次／ｍｉｎ,心律齐 ,各瓣膜区未闻及杂音。肝、脾不大 ,双下肢无水肿。Ｘ线胸片及超声心动描记术示心脏形态、结构正常。发作时心电图 (图１Ａ)示 :心室率２０５次／ｍｉｎ ,律齐 ,未见明显的房室分离。ＱＲＳ时间０．１１ｓ ,Ｖ１ 导联呈Ｒ型 ,Ｖ５ 呈ｒＳ型 ,电轴左偏 -７５°。食管心房调搏诱发出短阵心动过速 ,但未记…     

Q波进展型急性心肌梗死2例

例１患者男性 ,４３岁。吸烟后喉部灼痛伴胸闷、乏力、出汗２０ｍｉｎ就诊。体检 :ＢＰ１４／１０ｋＰａ(１０５／７５ｍｍＨｇ) ,两肺无殊 ,心率８２次／ｍｉｎ ,心律齐 ,各瓣膜无杂音。心电图 (图１Ａ)示窦性心律 ,心率７１次／ｍｉｎ ,ＴⅡ、Ⅲ、ａＶＦ 及ＴＶ２～Ｖ６ 增高或高耸 ;对应导联Ⅰ、ａＶＬ倒置 ,ＱＲＳ波群Ｖ１、Ｖ２ 呈Ｒｓ型，有巨大Ｊ波，Ｖ７～Ｖ９ 呈Ｑｒ型 ,疑为下后侧壁极早期心肌梗死 ,留院观察。６ｈ后 (图１Ｂ)示 :Ｔ波幅度降低 ,ａＶＦ出现Ｑ波 ,Ⅱ及Ｖ７～Ｖ９Ｑ波逐渐加深。心肌酶谱２０８４ｎｍｏｌｓ-１／Ｌ …     

Idiopathic verapamil-sensitive left ventricular tachycardia complicated by right ventricular outflow tract ventricular tachycardia and ventricular fibrillation.

Idiopathic ventricular tachycardias (VTs) are generally divided into those arising from the right ventricle and those arising from the left ventricle. There has been few reports of two morphologically distinct VT occurring in patients with no apparent structural heart disease. We report a patient with verapamil-sensitive left VT with a right bundle branch block pattern that spontaneously changed to VT with a left bundle branch block pattern. Ventricular fibrillation was induced by the application of programmed stimulation. Although it is unclear if our patient with pleomorphic VT has ventricular vulnerability, it is necessary to investigate further and follow him carefully.     

Isolated left ventricular noncompaction mimicking ventricular mass

Isolated left ventricular noncompaction is an inherited cardiomyopathy characterized by multiple prominent trabeculations with deep intertrabecular recesses. The diagnosis is often missed because echocardiography poses inherent problems of poor echo window in assessment of the LV apex, which is most commonly involved in noncompaction. We report a case in which conventional 2D echocardiography failed to demonstrate multiple prominent trabeculations. Contrast echocardiography confirmed the presence of multiple trabeculations with deep intertrabecular recesses. This report emphasizes the importance of contrast echocardiography in the diagnosis of ventricular noncompaction.     

Congenital ventricular diverticulum associated with ventricular tachycardia

Congenital ventricular diverticula are rare. Clinically, they may be asymptomatic or cause systemic embolization, heart failure, valvular regurgitation, ventricular rupture, ventricular arrhythmia, or sudden death. We report the case of a 56-year-old woman with sustained ventricular tachycardia, who, during investigation, was diagnosed with a diverticulum in the inferobasal portion of the left ventricle. The clinical characteristics and treatment of this rare disease are discussed.     

Left ventricular assist device-induced reverse ventricular remodeling

Left ventricular assist devices provide chronic pressure and volume unloading of the dilated left ventricle in patients with end-stage heart failure. This is associated with reverse structural remodeling (normalization of the passive pressure-volume relationship), reverse molecular remodeling (increased expression of several genes involved in calcium metabolism that are down-regulated in heart failure), improved baseline contractility, and improved contractile response to increased heart rate and to beta-agonist stimulation. These findings indicate the profound degree of recovery of myocardial properties in hearts previously considered to have invincible end-stage heart failure.