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患者,女,40岁。20年前劳累后出现心悸,气短,休息后即可缓解。17年来,因分娩2次症状逐渐加重,并间歇出现双下肢水肿。2月前因受凉后心悸,气短加重,夜间不能平卧。于1987年8月13日入本科。 体检:神清,口唇轻度紫绀,两肺呼吸音清晰,心界向两侧扩大。心率90次/min,节律不整,房颤律,胸骨左缘3～4肋间可闻及重级吹风样收缩期杂音,三尖瓣区亦可闻及吹风样收缩期杂音。腹平软,肝脾未触及,双下肢无水肿。心电图示频发房性早搏,短阵房颤,左心室肥大。超声心动图示右房,右室增大、房间膈连续不良。入院诊断:先天性心脏病,房间膈缺损,心功能Ⅲ级,心房纤颤。
Patient, female, 40 years old. Tired heart palpitations 20 years ago, shortness of breath, after the rest can be alleviated. In the past 17 years, symptoms gradually increased due to childbirth 2 times, and intermittent edema of both lower extremities. 2 months ago due to cold palpitations, shortness of breath worse, at night can not be supine. On August 13, 1987 into the undergraduate. Physical examination: God clear, lips mild cyanosis, lungs breath sounds clear, the heart to expand on both sides. Heart rate 90 beats / min, irregular rhythm, atrial fibrillation law, sternal left margin of 3 ~ 4 intercostal can be heard and heavy hair-like systolic murmur, tricuspid valve area can also smell hair-like systolic murmur. Abdomen soft, liver and spleen not touched, no lower extremity edema. ECG frequent atrial premature beats, short atrial fibrillation, left ventricular hypertrophy. Echocardiography right atrium, right ventricular enlargement, room diaphragm continuous poor. Admission diagnosis: congenital heart disease, diaphragmatic defect, cardiac function Ⅲ, atrial fibrillation.