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患者女,42岁。因心慌、胸闷、乏力半年加重10天。于1992年11月11日入院。查体:BP17/10kPa,双肺(-),心界向两侧扩大,心率90次/分,频发早搏,心尖区可闻Ⅱ/Ⅵ收缩期杂音,肝脾不大。EKG示窦律,频发室早,室内阻滞,左室肥大并劳损。超声心动图示左房左室轻度扩大,心室壁运动幅度明显减弱。诊断:扩张性心肌病,心功能Ⅱ级。查肝功、肾功、血生化均正常。入院后给予乙吗噻嗪150mg,1日3次,服药第四天突感胸闷、心悸、头晕伴出汗,BP 16/10kPa,EKG示室速、心室宰166次/分。立即静注利多卡因60mg,未转复,于10分钟又静注50mg,仍未转复,于1小时后静注心律平120mg,心率降至137次/分,仍未转复,约1小时再静滴130mg,转为窦律伴Ⅱ°房室传导阻滞,停用心律平2小时又转为室速,心室率160次/分,停用抗心律失常药物,给予极化液静滴,于发生持续性室速48小时,重复静注利多卡因60mg,40分钟转为窦律,改用慢心律150mg,一日3次,偶发室早,未再发生室速,好转出院。随访无室速发生。
Female patient, 42 years old. Due to palpitation, chest tightness, fatigue half-year increase of 10 days. Admitted to hospital on November 11, 1992. Physical examination: BP17 / 10kPa, lung (-), the heart to expand on both sides, heart rate 90 beats / min, frequent premature beats, apical area can be heard Ⅱ / Ⅵ systolic murmur, hepatosplenism. EKG showed sinus rhythm, frequent room early, intraventricular block, left ventricular hypertrophy and strain. Echocardiography showed mild left ventricular enlargement, ventricular wall amplitude was significantly weakened. Diagnosis: Dilated cardiomyopathy, heart function Ⅱ grade. Check liver function, kidney function, blood biochemistry are normal. Bthiazide 150mg, 3 times a day after admission. Sudden sense of chest tightness, palpitations, dizziness and sweating on the fourth day of medication, BP 16 / 10kPa, EKG show ventricular tachycardia, ventricular slaughter 166 times / min. Immediate intravenous injection of lidocaine 60mg, did not resume, intravenous injection of 50mg in 10 minutes, has not yet been restored, in 1 hour after intravenous injection of rhythm 120mg, heart rate dropped to 137 beats / min, has not been restored, about 1 Hour and then intravenous infusion of 130mg, to sinus rhythm with Ⅱ ° atrioventricular block, disable the rhythm of flat 2 hours and then converted to VT, ventricular rate of 160 beats / min, anti-arrhythmic drugs disabled, given the polarization of static Drip, continuous ventricular tachycardia occurred in 48 hours, repeated intravenous lidocaine 60mg, 40 minutes to sinus rhythm, switch to slow heart rate 150mg, 3 times a day, sporadic room early, no further ventricular tachycardia, improved discharge. Follow-up occurred without VT.