讨论一、本例的诊断问题本例患者在病史、体征及实验室方面,有下列发现:(1)长期呼吸困难和慢性咳嗽史,痰多、带脓性,有时咯血;(2)全身浮肿(特别是下肢)及尿少一个月余;(3)粘膜紫绀;(4)颈静脉怒张,肝肿,肝颈反流试验(+),(5)桶状胸、心肝浊音界减小,两肺满布于湿啰香;(6)肺动脉瓣第二音大于主动脉瓣第二香;(7)腹水;(8)杵状指;(9)臂肺循环时间延长,静脉压增高,(10)X 线上的发现。根据这些发现,患者有心脏病右心室衰竭当无疑问,现就心脏病的病原学诊断,分别进行讨论如下:1.左心室衰竭在晚期可发展成全心衰竭,同时出现右心室衰竭。左心室衰竭的常见原因为高血 DISCUSSION 1. Diagnostic problems in this case The following findings were found in the patient’s history, signs and laboratory: (1) long-term dyspnea and history of chronic cough, sputum, purulent, and sometimes hemoptysis; (2) generalized edema (Especially the lower extremities) and urine less than a month; (3) mucosal cyanosis; (4) jugular vein engorgement, hepatomegaly, liver neck reflux test (+), , Both lungs covered with wet ramie; (6) the second pulmonary valve more than the second aroma of the aortic valve; (7) ascites; (8) clubbing means; (9) arm pulmonary circulation prolonged venous pressure increased, (10) X-ray findings. Based on these findings, patients have heart failure with right ventricular failure. Without a doubt, the etiological diagnosis of heart disease is now discussed separately as follows: 1. Left ventricular failure develops late stage full heart failure with right ventricular failure. The common cause of left ventricular failure is high blood