临时心脏起搏器机械刺激诱发室性心动过速1例

正1临床资料患者,男性,68岁,主因胸痛4 h入院。既往高血压病史7年,有脂肪肝病史2年,否认糖尿病、心肌炎病史,患者既往无心悸、黑曚、晕厥病史。查体:无发热,呼吸平稳,血压128/80 mmH g(1 mmH g=0.133 kP a),双肺无干湿性啰音,心律齐,心率60次/min,未闻及杂音及额外心音,余无异     

体外程控心脏起搏器转复持续性室性心动过速一例

患者 ,男性 ,70岁。因冠心病、广泛心内膜下心肌梗死 ,充血性心力衰竭于 1993年 11月 4日入院。住院期间曾出现交替性左右束支阻滞、Ⅲ度房室阻滞 ,反复发作阵发性心房颤动、心房扑动。 1994年 3月 4日突发持续性室性心动过速(ＶＴ)、心室颤动、心室停顿合并阿斯综合征、呼吸停止 ,在常规心肺复苏的同时 ,予心前区经胸壁置入双极起搏钢丝 ,行心内膜紧急起搏 ,复苏成功。因未出现窦性心律 ,15ｈ后安置永久性ＶＶＩ心脏起搏器 (ＣＰＩ公司ＶＩＳＴＡ6 44 4)。术后仍有ＶＴ发作 ,静脉注射利多卡因或普罗帕酮可终止发作 ,但 7月 15日ＶＴ发作时…     

吞咽诱发室性心动过速2例

吞咽诱发房性心动过速的病例偶有报道,但吞咽诱发室性心动过速的病例极为罕见,现报告2例。 例1,男,64岁,农民,因心慌气短,进食时加重而来我院检查。根据有关检查资料和病史,临床诊断为:高血压病、冠心病。在进行24小时动态心电图检查时,发现有室性早搏156个,成对室早9个,室速8阵,室上性早搏978个,室上性心动过速168阵。将室速出现的时间与患者佩带动态心电图记录时所作的生活日志相对照,发现8阵室速均发生于吃饭或吃水果时。室性早搏及成对室早也主要发生于这个时间范围     

右室流出道室性心动过速诱发心动过速性心肌病1例

1病例资料患者,女,36岁,因发作性心悸10年余,加重伴胸闷、气短4d入院。既往频发室性期前收缩10年余,否认有高血压、糖尿病、心肌病、感染、自身免疫性疾病、家族遗传病及猝死史。在我院急诊室体检:脉搏214次/min,血压95/65mmHg(1mmHg=0.133kPa),心律整齐,各瓣膜听诊区未闻及病理性杂音,双下肢无水肿。     

特发性室性心动过速1例

患者男性,48岁。反复发作性心悸2年余,加重1个月。近2年来常因情绪激动突然出现心慌、气短、头痛、头晕,严重时偶有胸痛,每月约2～3次,一般持续10余min,有时不用任何药物也可缓解。近一个月来,发作频繁,达5～6次,持续30min至1 h,故来院就诊,心电图诊断为心律     

房性心动过速和室性心动过速并存1例

患者,女性,65岁,因反复胸闷、心悸10余年,加重1个月求诊。3年前心脏超声示:左心室肥大,左心房肥大,肥厚性心肌病(心尖肥厚性)。临床诊断为肥厚性心肌病。常规心电图(图略):窦性心律,左心房肥大,左心室肥大,心室内传导阻滞,ST-T     

Dows诱发尖端扭转性室速和室性心动过速1例

患者女性,38岁。蒙古族。周期性阵发性心悸、胸闷、气短1周、加重1天人院。BP：110／70mmHg,T36．7℃,R20次／分,体检：双肺（～）,心音强弱不等,心率：60～70次／分、心律不齐、未闻及病理性杂音、腹（-）、心（-）、实验室检查：生化全项正常,心脏彩超正常。人院记录心电图（图1）为尖端扭转性室速（Tdp）和室性心动过速（VT）,补钾4g效果不佳。给予电击除颤用180W,虽可短暂终止但不能纠正反复发作之Tdp。给予异丙基肾上腺素0．5mg溶于滴注,持续24小时,8小时仍然复发Tdp。给予临时起搏转为窦性节律（图略）。     

室性期前收缩长短周期现象诱发多形性室性心动过速1例

患者女性,14岁,因反复阵发性心悸伴晕厥半年来院就诊。体检:平卧位,T36.5℃,R21次/min,BP110/75mmHg,心界不大,心率84次/min,心律不齐,各瓣膜区未闻及病理性杂音。两肺无殊。腹软,肝脾未及。实验室检查:血常规、肝肾功能、血清电解质及心肌酶谱均正常。X线胸片示心影大小及形态均正常。超声心动描记术示各房室腔未见增大。临床诊断:晕厥待查。常规心电图(图略)示窦性心律,室性期前收缩。24h动态心电图(图1A)示:窦性P-P间期基本匀齐,为0.68s,Q-T间期0.36s,从第1个室性期前收缩QRS波群起始至下一窦性QRS波群起始间期为1.36s,已达窦性周…     

分支性室性心动过速1例

患儿,女性,9个月9天。因心率快1月入院。临床诊断心肌炎,心律失常。图1示:心房率150次/min,心室率187次/min,P P规整,R R规整,P波与QRS波无固定关系。Ⅰ、aVL导联呈rS型,Ⅱ、Ⅲ、aVF导联呈qR型,V1导联呈qRs型,V5导联呈rS型,电轴+150°,QRS时间0.12s。心电图诊断:分支性室性心动过速。给予心律平10mg静推,转为窦性心律(图2):窦性P QRS T顺序发生,频率150次/min,Ⅱ、Ⅲ、aVF导联呈rS型,V1导联呈Rs型,V5导联呈RS型。动态心电图22h发生室性早搏567次/min,占总心率的3.5‰。讨论心动过速发作时室性QRS波时间≤0.12s,呈右束支传导…     

Impending paradoxical embolism visualized by echocardiography combined with pulmonary embolism: a case report

A 43-year-old man was admitted to our hospital complaining of dyspnea on exertion and dizziness. Transthoracic echocardiography revealed a mobile mass (3.5 x 1.0 cm) attached to the left atrial septum and transesophageal echocardiography showed the mass in the right atrium protruding through the patent foramen ovale into the left atrium. A mobile snake-like thrombus was apparent in the right atrium and right ventricle. The diagnosis was pulmonary embolism with impending paradoxical emboli.     

肺结核合并肺栓塞1例

<正>结核病(tuberculosis,TB)是全球尤其是发展中国家的重大社会公共卫生问题,严重危害人民群众身体健康。我国是全球30多个结核病高负担国家之一,每年新发结核病患者约90万例,位居全球第3位~([1])。2010年我国第五次全国流行病学调查显示:15岁以上人群活动性肺结核患病率为459/10万,涂阳肺结核患病率为66/10万,菌阳肺结核患病率为119/10万~([2])。肺栓塞(pulmonary embolism,PE)是常见致死性血管疾病,因其临床症状多样性及非特异性而极易被     

Complications of warfarin therapy monitored by the international normalized ratio versus the prothrombin time ratio

The objective of our study was to determine the rates of bleeding complications and thromboembolic events in patients receiving oral anticoagulant therapy monitored with the prothrombin time (PT) ratio versus therapy monitored with the International Normalized Ratio (INR) using a retrospective time-series study design. Over 650 patients enrolled in a large anticoagulation clinic were studied during two time periods corresponding to the use of the PT ratio versus the INR to guide anticoagulant therapy, with over 400 patient-years of follow-up for each time period. The rate of bleeding complications using the PT ratio to guide therapy was 6.7% (1.2% major, 5.5% minor) per patient-year, compared with 2.9% (0% major, 2.9% minor) using the INR (p = 0.02). The rate of thromboembolic complications was 1.0% using the PT ratio, compared with 0.2% using the INR (p = NS). Therapy monitored with the INR required 19.8 visits per year, compared with 20.7 visits per year using the PT ratio. We conclude that the INR should be used to monitor oral anticoagulant therapy in an effort to reduce bleeding complications while maintaining an acceptable rate of thromboembolic events.     

慢性心力衰竭漏诊肺栓塞1例

正1对象和方法患者男性,65岁,陕西榆林人,3个月前因"间断发热伴咳嗽、咳痰1周"于当地医院就诊,胸部CT提示"肺部感染",诊断为"肺脓肿、包裹性胸腔积液(左侧)、肺气肿、肺大泡、支气管扩张",给予抗生素治疗(先后曾使用利奈唑胺、亚胺培南西司他丁、阿奇霉素、头孢唑林等抗生素,剂量不详)23 d,后症状逐渐好转。然而12 d前咳嗽咳痰     

Paradoxical brain embolism caused by pulmonary arteriovenous fistula and coincident pulmonary embolism--a case report

The authors encountered a very rare case of paradoxical brain embolism resulting from pulmonary arteriovenous fistula and coincident pulmonary embolism. Enhanced computed tomography was useful for diagnosing this infrequent condition.     

Massive pulmonary embolism in a patient with ulcerative colitis and hyperhomocysteinaemia -- a case report

We describe a case of a 37-year-old man with active ulcerative colitis complicated by proximal deep vein thrombosis of the left lower limb and subsequent massive pulmonary embolism requiring mechanical ventilation and catecholamine infusion. In spiral CT a large thrombus obturating left pulmonary artery as well as bilateral embolic material in lobar and segmental branches were visible. Haemodynamic status improved after infusion of rtPA. Haemoglobin decrease (7.0-5.6 mmol/L) was corrected with erythrocyte mass transfusion. During subsequent therapy with intravenous full dose of unfractionated heparin and further long-term treatment with subcutaneous enoxaparin (1.5 mg/kg and after 3 months 1.0 mg/kg daily) haemoglobin value was relatively stable. Underlying disease was treated with 5-ASA (mesalazine) and steroids. Due to hyperhomocysteinaemia (16.0 micromol/L) coexisting with a low plasma folic acid (2.1 ng/ml) and cyanocobalamin (137 pg/ml) levels, supplementation with these vitamins was prescribed. The screening tests for familial thrombophilia (including 677C-->T MTHFR mutation) were negative. The authors discuss the pathogenesis of increased thromboembolic risk in inflammatory bowel disease and therapeutic dilemmas connected with treatment of such complications.     

Rheolytic thrombectomy in patient with massive pulmonary embolism: a case report and review of literature.

OBJECTIVE: Despite advances in management with thrombolytic therapy or open embolectomy, the mortality rate remains high in patients with massive pulmonary embolism (MPE). BACKGROUND: We present a case of 51-year-female patient who collapsed while jogging and was brought to the Emergency Department. Upon arrival, she was found to have marked hypotension and hypoxia. EKG showed marked ST T abnormalities suggestive of anterior and lateral ischemia. Blood was drawn for labs. Patient received aspirin, heparin, and was transferred to cardiac catheterization laboratory. METHODS: Coronary angiogram revealed normal epicardial coronaries. A pigtail catheter was inserted through right femoral vein and pulmonary angiogram was performed. It revealed bilateral MPE. Tissue plasminogen activator was initiated as per standard protocol. A 7-French aspiration catheter (Export, Medtronic Vascular, Santa Rosa, CA) was used without any success. Rheolytic thrombectomy (RT) (AngioJet, Possis, Minneapolis, MN) was performed successfully with adjunctive local and systemic thrombolytic therapy. Immediate pulmonary angiogram showed increased perfusion through right pulmonary artery. Her hemodynamic status improved significantly. Patient was discharged home after 8 days of hospitalization. Patient remains on lifelong anticoagulation therapy and she continues to remain stable at 20 months follow up. CONCLUSIONS: RT with adjunctive localized and systematic thrombolytic therapy was performed successfully in this patient with MPE and significant hemodynamic compromise. In our patient who was very unstable from cardio-respiratory perspective with maximized hemodynamic support, RT device use was life saving. RT has an advantage of not dispersing emboli particles to the distal pulmonary circulation.     

Complete atrioventricular block caused by pulmonary embolism: A case report and review of literature

IntroductionAcute electrocardiogram abnormalities are common in patients afflicted with pulmonary embolism (PE). Rarely, a patient with acute pulmonary embolism and electrocardiogram changes may have an underlying conduction abnormality that complicates their course.Case presentationWe describe a patient with known history of left bundle branch block who presented with acute PE and developed a right bundle branch block, which devolved into complete third degree heart block without ventricular escape rhythm and led to concomitant hemodynamic compromise.DiscussionGiven the rarity of this clinical scenario, we call for clinicians to be aware of PE-associated conduction pathology as well as the possibility that malignant cardiac conduction blocks may occur in the setting of PE particularly if the patient is known to have underlying conduction system disease. We emphasize the importance of continuous telemetry monitoring in patients presenting with PE as these types of arrhythmic complications and hemodynamic decompensation has been observed.