丁××女性43岁患者因反复咳嗽二十余年,一月来加剧伴浮肿诊断为类风湿性心脏病心力衰竭于1979年4月5日入院。患者于14～15岁时曾患四肢小关节疼痛,活动受限,卧床一月。约2年后发现掌指及足趾关节相继出现增粗变形。19年来因手指足趾关节严重畸形,活动不利而丧失劳动力。有廿余年咳嗽病史,一年来加剧,稍动则喘,时有下肢浮肿。体检:二尖瓣面容,颈静脉充盈,未见皮下小结。桶状胸,心界明显向左扩大,心尖搏动弥散有抬举感。心尖区可闻及Ⅲ级收缩期吹风样杂音及Ⅱ级舒张期雷鸣样杂音,主动脉瓣区可闻及Ⅱ～Ⅲ级收缩期 Ding × × female 43-year-old patient due to repeated cough for more than twenty years in January to exacerbate edema diagnosed with rheumatic heart disease heart failure on April 5, 1979 admission. Patients from 14 to 15 years old had limbs joint pain, limited mobility, bed in January. About two years later, the metacarpophalangeal and toe joints were found to have thickening and deformation. 19 years due to severe deformity of the fingers and toe joints, adverse events and loss of labor. Have more than 20 years history of cough, exacerbated a year, a little while is asthma, sometimes lower extremity edema. Physical examination: mitral valve surface, filling the jugular vein, no subcutaneous nodules. Bucket-shaped chest, the heart was significantly expanded to the left, apex pulsation with a sense of lifting dispersion. Apex area can be heard and Ⅲ grade systolic hair-like murmur and Ⅱ diastolic throat-like murmur, aortic valve area can be heard Ⅱ ~ Ⅲ systolic