心尖球形综合征一例

1病例资料患者男性,62岁,因活动性胸闷、气促伴双下肢水肿1周于2010年4月26日入院。入院前一周因受凉后出现活动性胸闷、气促、双下肢水肿,伴咳嗽、咳少量白痰,夜间不能平卧。4月19日曾至外院就诊查心电图：窦速,左室肥厚,     

心尖球形综合征3例

患者1,女,68岁,因持续性胸痛伴呕吐16h入院。患者当晚饮酒后,出现胸骨中段持续性疼痛,手掌范围大小,向左肩部放射,伴呕吐3次,为胃内容物。入院查肌酸激酶同工酶(CK-MB)69IU/L,肌钙蛋白(cTnI):7.93μg/L;心电图(见图1)示:     

"心尖球形综合征"1例

患者,女,72岁.因胸痛1个月、加重5 h入院.起病始于1个月前,患者在护理其患病丈夫时,其丈夫身体失衡,手掌重重压在患者胸前,患者突感胸骨后剧烈压榨样痛,同时背部隐痛,伴呼吸困难、微汗,持续达5 h左右症状缓解,当时胸片检查提示第4、6肋骨骨折,但未行心电图检查,诊断为肋骨骨折,行相应治疗后症状渐缓解.     

识别心尖球形综合征

心尖球形综合征（apical ballooning syndrome）可能是一种急性扩张性心肌病,特点为突然发生类似心绞痛样的胸痛;心电图表现有典型的ST段抬高、多导联T波倒置和异常的QS波;超声心电图或左心室造影见前壁下部和心尖部有非连续性室壁运动异常;有限的心肌酶释放。其临床表现类似急性心肌梗死。但多发生于冠状动脉造影没有发现狭窄的明显血流动力学证据的病人。这些病例虽然有明显的心室收缩功能损害。但有突然起病后快速好转的特点。而且以女性居多。     

应激性心肌病一例

患者,女性,82岁.因"间断胸痛16年,加重伴胸闷半天"于2012年8月6日来我院就诊.患者分别于1996年及2008年2次确诊为急性心肌梗死.入院当日凌晨情绪极度激动时出现胸痛,伴胸、闷心悸,无黑朦、晕厥,无意识障碍、肢体活动受限,持续8小时无缓解.于门诊测血压116/62 mm Hg,心率66次/分,律齐,心尖区可闻及2/6级收缩期吹风样杂音.     

心尖球形综合征患者心电图与临床特征分析

目的了解国人心尖球形综合征（ABS）的心电图与临床特征。方法对2011年4月以前国内医学期刊报道的105例ABS患者心电图资料进行汇总分析。结果中老年女性多见,105例患者均为窦性心律,97．1％的患者出现心电图异常改变,其中83．8％伴ST段抬高,ST段抬高幅度0．1至0．8mv,抬高的ST段在30min至1周回落;42．9％的患者出现T波倒置,29．5％的患者出现病理性Q波,在6h至1个月内消失;23．8％的患者QTc间期延长,38％的患者并发心律失常。结论国人ABS的心电图异常改变发生率高,其特征为异常改变呈暂时性和可逆性。     

心尖肥厚型心肌病18例报告

心尖肥厚型心肌病属于非梗阻型心肌病的一种，临床少见。本文对１８例患者的临床表现、心电图、超声心动图及磁共振成像特点进行了分析。心电图的典型改变是胸前导联巨大倒置的Ｔ波，高ＱＲＳ波群；超声心动图特点为心尖部肥厚或闭塞，左室流出道无梗阻。磁共振成像证实心尖部心肌肥厚。心室造影呈＂铲形＂（Ｓｐａｄｅ－ｌｉｋｅ）。该病常被误诊为＂冠心病＂、＂心内膜下心肌梗塞＂。国外有关报道指出，以心电图倒置Ｔ波深度＞１０ｍｍ做为诊断该病的标准。而本文作者却观察到，一部分患者心电图倒置Ｔ波深度＜１０ｍｍ，且有的患者心室造影不呈＂铲形＂。故作者认为后者是该病的一种新的类型。超声心动图是诊断该病的重要手段，必要时可做磁共振成像检查。该病对血液动力学影响较小，因影响左室舒张功能，故引起一些临床症状。该病预后一般较好。     

心尖球形综合征心电图1例

患者女性，45岁，因突发胸痛、心悸、气短30min伴黑朦1次即刻入院。既往有高血压3年，无心脏病史。体检：BP80／50mmHg，精神萎靡，面色苍白，心率58次／min，心律齐，第1心音明显低钝，未闻杂音。两肺呼吸音清。腹部无殊。急查心电图（图1A）示窦性心律，心率78次／min，P—R间期0．17s，QRS波群aVL、V1～V3呈QS型，     

左室心尖球形综合征1例

患者,男性,66岁,入院前2 h无明显诱因突发胸前区压榨样疼痛,伴有大汗、气短,症状呈持续性,无咳嗽,晕倒过1次,晕倒时神志清,无抽搐.既往有冠心病史.体格检查:心界无扩大,心率75次/分,律齐,心音低钝,血压100/60 mmHg,口唇无发绀,颈静脉无怒张,双下肺部可闻及细湿性哕音.     

糖尿病患者合并眶尖综合征一例

患者,女,45岁,"发现血糖升高10年,消瘦,乏力伴发热20天"就诊.该患者10年前发现血糖升高,间断口服各类降糖药物治疗,未监测血糖.20天前无明显诱因出现消瘦、乏力,体重下降10 kg左右,伴发热,食欲下降.     

Kearns-Sayre综合征一例

线粒体脑肌病是一组线粒体功能异常的疾病,可导致骨骼肌、脑、心脏等脏器功能障碍,临床上可分为慢性进行性眼外肌瘫痪(CPEO)、Kearns-Sayre综合征(KSS)、线粒体脑肌病伴高乳酸血症和卒中样发作综合征和肌阵挛性癫痫伴肌肉破碎红纤维等类型.典型的KSS表现为CPEO、视网膜色素变性、心脏传导系统缺陷三联征.本文报道1例完全型KSS.     

A case report of Byler's syndrome

The case report describes a progressive familial intrahepatic cholestasis II type Byler's syndrome with structural abnormality of the bile canalicular membrane. A child with a rare hereditary pathology,who is on the waiting list for liver transplantation, on the background of complex treatment, including diet therapy, drug therapy achieved a positive dynamics of clinical and laboratory parameters, acceleration of physical, psychomotor and intellectual development, that in general has improved the surgery prognosis and quality of life of the patient.     

A case report of Refetoff's syndrome

An 11-year-old girl with diffuse goiter is presented. She had no clinical evidence of thyrotoxic symptoms or signs of palpitation, excessive sweating, tachycardia or finger tremor. Both the serum T4 (24.0 micrograms/dl) and T3 (282ng/dl) were high, and thyroid 131I uptake rate (63.2%) was significantly elevated, but T3/T4 ratio was not elevated (11.8). BMR was measured three times and remained within normal limits. Her serum TSH was 1.9 microU/ml, and a TRH stimulation test resulted in a normal rise of serum TSH (13.4 microU/ml). The TSH secretion was not suppressed by medication (p.o.) of 75 micrograms of L-triiodothyronine given for 8 days. The autoantibodies of T4, T3 and TSH were negative. No sign of pituitary tumor was observed by plain X-ray film. No defect in her sight-field was found. From these clinical figures and data, Refetoff's syndrome was suspected. She was eumetabolic without any treatment, but the goiter gradually enlarged and dysphagia developed. A large dose of L-thyroxine (450 micrograms/day) was given for a period of one year and four months. She has been eumetabolic. Her goiter disappeared and the dysphagia completely subsided. After she was given large doses of L-T4, her serum TSH was reduced to 0.07 microU/ml and was slightly elevated to 0.24 microU/ml at 30 min after i.v. infusion of 500 micrograms TRH. Thyroid 123I uptake rate was suppressed to 8.3%. According to Refetoff's papers, this case was classified as being in the group with generalized resistance to thyroid hormone.     

Timothy综合征一例

Timothy综合征是一种罕见的多器官障碍的遗传性疾病,1989年Timothy教授首次报道,也称为长QT综合征8型.山东大学附属省立医院小儿心脏科收治1例,现报道如下：     

Kearns-Sayre综合征一例

线粒体脑肌病是一组线粒体功能异常的疾病,可导致骨骼肌、脑、心脏等脏器功能障碍,临床上可分为慢性进行性眼外肌瘫痪(CPEO)、Kearns-Sayre综合征(KSS)、线粒体脑肌病伴高乳酸血症和卒中样发作综合征和肌阵挛性癫痫伴肌肉破碎红纤维等类型.典型的KSS表现为CPEO、视网膜色素变性、心脏传导系统缺陷三联征.本文报道1例完全型KSS.     

Kearns-Sayre综合征一例

线粒体脑肌病是一组线粒体功能异常的疾病,可导致骨骼肌、脑、心脏等脏器功能障碍,临床上可分为慢性进行性眼外肌瘫痪(CPEO)、Kearns-Sayre综合征(KSS)、线粒体脑肌病伴高乳酸血症和卒中样发作综合征和肌阵挛性癫痫伴肌肉破碎红纤维等类型.典型的KSS表现为CPEO、视网膜色素变性、心脏传导系统缺陷三联征.本文报道1例完全型KSS.     

Holt-Oram syndrome: A case report

Holt-Oram syndrome is clinically characterized by morphological abnormalities of the upper limbs and congenital cardiac defects. Although the disease is congenital, the diagnosis may only be made later in life. It is a rare autosomal dominant disorder, caused by a mutation in the TBX5 gene located on chromosome 12, but sporadic cases have also been reported. We describe the case of a 75-year-old man with known morphological alterations of the upper limbs since birth and congenital cardiac defect (atrial septal defect), who later in life also manifested with advanced atrioventricular block.     

Gardner综合征1例报道

背景Gardner综合征是常染色体显性遗传病,主要表现为多发性胃肠道息肉、软组织肿瘤和骨瘤.它比较罕见,相关报道较少,但其恶变率高,因此对该病有全面认识对治疗具有重要意义.病例简介我们报告1例被确诊为Gardner综合征的39岁男性患者,因贫血、黑便4月余,伴恶心呕吐20天来院诊治.胃肠镜检查发现胃肠道多发息肉,息肉活检病理证实该疾病诊断,我院医生即对其行内镜下治疗,患者术后恢复良好,黑便症状缓解,贫血症状也有所改善.结论Gardner综合征的临床表现复杂,因此要求医生能更加敏锐地将患者临床表现与影像学和病理检查结果相结合,尽早诊断和治疗,使病情得到有效的控制,改善疾病预后.