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患者女性,65岁,以突发心前区闷痛不适10小时来诊。病人于休息时突感心前区闷痛,含服消心痛(10mg)不能缓解。查体:T:36.6℃、脉搏 108次/min,血压 140/100mmHg,神志清,精神差,发育正常,浅表淋巴结不大,颈软,心音低钝,律规整,肝脾肺正常,布氏征(-),巴氏征(-)。心电图:Ⅱ、Ⅲ、aVF,V_1～V_6ST段压低1～3mV,T波倒置或双向,提示心绞痛发作。心肌酶谱、血电解质、肝功、肾功、血尿常规均正常。拟诊为冠心病、心绞痛。治疗:高流量吸氧,持续静滴硝酸甘油,口服肠溶阿斯匹林、卡托普利、倍他乐克。施治2天,疼痛仍频繁发作并出现头痛及恶心呕吐。查:颈项略抵抗,克氏征可疑。眼底示:双侧视乳头边界欠清。脑CT证实:蛛网膜下腔出血。治疗改为脱水降颅压,脑脊液置换,口服消心痛。1天后,该病人心前区闷痛次数减少,3天后完全缓解,住院5周,治愈出院。
Female patient, 65 years old, in order to sudden boring pain uncomfortable 10 hours to visit. Suddenly, the patient was relieved when the patient was depressed at the time of rest. The abatement of heartache (10mg) was not alleviated. Examination: T: 36.6 ℃, pulse 108 beats / min, blood pressure 140 / 100mmHg, clear mind, poor spirit, normal development, superficial lymph nodes, soft neck, low heart sound blunt, ’S sign (-), Pakistan’s sign (-). ECG: Ⅱ, Ⅲ, aVF, V_1 ~ V_6ST segment depression 1 ~ 3mV, T wave inversion or bidirectional, suggesting angina pectoris. Myocardial enzymes, blood electrolytes, liver function, kidney function, hematuria routine are normal. To be diagnosed as coronary heart disease, angina pectoris. Treatment: high-flow oxygen, continuous intravenous nitroglycerin, oral enteric-coated aspirin, captopril, Betaloc. 2 days of treatment, the pain is still frequent attacks and headache and nausea and vomiting. Check: Neck slightly resistant, Kirk sign suspicious. Fundus shows: bilateral optic disc border less clear. Brain CT confirmed: subarachnoid hemorrhage. Treatment of dehydration reduced intracranial pressure, replacement of cerebrospinal fluid, oral anti-heartache. One day later, the number of nausea and pain in the anterior pituitary gland of the patient decreased and was completely relieved after 3 days. The patients were hospitalized for 5 weeks and were cured and discharged.