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患者,男,55岁。自1990年1月13日始无明显诱因感心悸、胸闷,曾多次在当地卫生院以“冠心病合并房颤”治疗,并获间断缓解。2个月后发作渐频繁。后因心慌、胸闷、胸骨后隐痛治疗无效,于1990年4月4日收住我院。既往否认心脏病史,无高血压病史。入院查:体温、血压正常。消瘦,未触及浅表淋巴结。发音略低沉。双肺(-)。心界叩诊正常,心率108次/分,呈房颤律,无明显杂音。腹部检查未见异常。血常规:Hb100g/L,WBC7.4×10~9/L,N0.60,L0.40。心电图示快速房颤。胸片示上纵隔略宽,肺野(-)。心脏 B 超未见异常。入院给予综合治疗,患者房颤转为窦性心律、心动过缓。但声嘶逐渐加重。第8天行喉镜检查发现右侧声带麻痹,体检发现右颈中淋巴结肿大约1×2cm。复查
Patient, male, 55 years old. Since January 13, 1990 no obvious incentive to start feeling palpitations, chest tightness, many times in the local hospitals to “coronary heart disease complicated by atrial fibrillation,” and intermittent relief. 2 months after the onset of more frequent. After due to palpitation, chest tightness, sternum after treatment of pain is invalid, in April 4, 1990 admitted to our hospital. Previously denied a history of heart disease, no history of hypertension. Admission check: body temperature, normal blood pressure. Weight loss, did not touch the superficial lymph nodes. Slightly lower pronunciation. Double lung (-). Heart percussion normal, heart rate 108 beats / min, atrial fibrillation law, no obvious noise. Abdominal examination showed no abnormalities. Blood: Hb100g / L, WBC7.4 × 10 ~ 9 / L, N0.60, L0.40. ECG rapid atrial fibrillation. Chest radiograph showed a slightly wider mediastinum, lung field (-). B-heart abnormalities were not seen. Admission to the comprehensive treatment of patients with atrial fibrillation into sinus rhythm, bradycardia. However, hoarseness gradually increased. On the 8th day laryngoscopy found that the right vocal cord paralysis, physical examination found that the right neck lymph nodes about 1 × 2cm. Review