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患者,男,75岁、因阵发性头晕、心悸3天于1993年1月14日急诊入院.3天前患者无明显诱因出现阵发性头晕、短暂黑蒙,伴心悸、烦躁、夜不能眠.无意识及肢体活动障碍.既往有三叉神经痛20余年,高血压病10年,平时未服药.两年来坚持服卡马西平治疗.5天前因饮酒致三叉神经痛加重,每天口服卡马西平900～1200mg(江苏常州国营武进制药厂出品,批号920707).体检:T36.3℃,BP24.0/9.3kPa,HR49次/分,神清,双肺呼吸音清,心界向左扩大,心律齐.A_2>P_2,心尖部闻及SM Ⅱ/6,主动脉瓣区闻及SM Ⅱ/6及DM,肝脾未触及,下肢无水肿.ECG示交界性逸搏心律,HR47次/分,左室肥大伴劳损.心脏B超示左室明显扩大,主动脉瓣关闭不全,升主动脉扩张.入院诊断:高血压病缓进型Ⅱ期,主动脉瓣关闭不全,左心室扩大,交界性逸搏心律.入院后入CCU,经吸氧,口服消心痛、心痛定、卡托普利等药,血压降至20/8kPa.予654-2针20mg加5%葡萄糖500ml静滴,心律变为窦性与交界性心律交替出现,窦性静止(可能为Ⅱ°～Ⅲ°窦房阻滞交界性逸搏心律).窦率60次/分,交界性逸搏心率40次/分.后以5%葡萄糖液500ml加异丙肾上腺素1mg静滴,窦性静止仍未见好转.疑为卡马西平所致.嘱减少卡马西平用量,加用野木瓜丸及安络酮口服.当卡马西平减为300mg/d时,窦性静止消失.ECG示
Patient, male, 75 years old, due to paroxysmal dizziness, palpitations 3 days emergency admission on January 14, 1993. 3 days before the patient had no obvious incentive to paroxysmal dizziness, transient darkness, palpitations, irritability, night can not Sleepless unconsciousness and limb movement disorders.Previous trigeminal neuralgia for more than 20 years, hypertension 10 years, usually not taking medicine .2 years adhere to take carbamazepine treatment .5 days ago due to alcohol consumption caused by increased trigeminal neuralgia, oral Kama daily Xiping 900 ~ 1200mg (Changzhou, Jiangsu state-owned Wujin Pharmaceutical Factory, batch number 920707.) Physical examination: T36.3 ℃, BP24.0 / 9.3kPa, HR49 beats / min, Shen Qing, lung breath sounds clear, , Heart rhythm.A_2> P_2, apical scent and SM Ⅱ / 6, aortic valve area smell and SM Ⅱ / 6 and DM, liver and spleen not touched, lower extremity no edema.ECG showed border esophageal atrial rhythm, HR47 times / Points, left ventricular hypertrophy with strain.The heart B-ultrasound showed a significant expansion of the left ventricle, aortic valve regurgitation, ascending aorta dilatation.Admission diagnosis: Hypertensive slow-Ⅱ, aortic valve insufficiency, left ventricular enlargement, Junctional esophageal rhythm.After admission into the CCU, the oxygen, oral anti-heartache, painkillers, captopril and other drugs, blood pressure dropped to 20 / 8kPa. To 654-2 needle 20mg plus 5 % Glucose 500ml intravenous infusion of arrhythmia and junctional arrhythmia alternating sinus, sinus at rest (may be Ⅱ ° ~ Ⅲ ° sinoatrial junctional escape esophageal arrhythmia) sinus rate of 60 beats / min, junctional escape Beat heart rate 40 beats / min after 5% glucose solution 500ml plus isoproterenol 1mg intravenous infusion, sinus static still has not improved. Suspected carbamazepine due. Will reduce the amount of carbamazepine, plus wild papaya Pills and enoxaparin orally. When carbamazepine was reduced to 300mg / d, sinus static disappeared.