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患者,男,53岁。因生气后于1996年6月5日晨4时许突发胸闷,心悸,压榨性胸疼2小时急性入院。查体:R22次/min,P40次/min,BP7/4kPa。面色苍白,大汗淋漓,四肢湿冷,颈静脉明显充盈。心音极弱,心率41次/min,节律整齐,即刻查心电图(ECG),为Ⅱ°房室传导阻滞,V1导联ST段抬高约0.15mV,余无明显变化。其后加作V3R、V4R、7时查ECG;房率均齐,为94次/min,室率慢而均齐为41次/min,V1,V3R,V4RST段呈弓背向上样抬高约0.15～0.1mV,T波直立,其上升支与ST段略有融合,Ⅰ Ⅱ avFV7,V8ST段下移约0.15～0.1mV,T波直立,诊断:①Ⅲ°房室传导阻滞,②急性右室心肌梗塞?(急性期),立即给予吸氧,用升压药加激素等治疗。 于1小时后复查ECG:房率为112次/min,室率为41～60次/min,且有窦性P波下传心室为心室夺获,与7时比较:SV1波明显变浅,ST段抬高约有0.15～0.1mV,STV2、V3下移约0.1～0.2mV,Ⅱ、Ⅲ
Patient, male, 53 years old. Due to anger in the morning of June 5, 1996 at 4:00 on the morning of the sudden onset of chest tightness, palpitations, 2 hours acute chest pain exacerbation. Physical examination: R22 times / min, P40 times / min, BP7 / 4kPa. Pale, sweating, cold limbs, jugular vein significantly filling. Very weak heartbeat, heart rate 41 beats / min, rhythm and neat, immediately check the electrocardiogram (ECG), Ⅱ ° atrioventricular block, V1 lead ST segment elevation of about 0.15mV, the remaining no significant change. Then add V3R, V4R, 7:00 check ECG; rate were homogeneous, 94 times / min, room rate is slow and homogeneous Qi 41 times / min, V1, V3R, V4RST segment was bow back up loading about 0.15 ~ 0.1mV, T wave upright, the rising branch and the ST segment slightly fusion, Ⅰ Ⅱ avFV7, V8ST segment down about 0.15 ~ 0.1mV, T wave upright, diagnosis: ① Ⅲ ° atrioventricular block, ② acute right ventricular myocardium Infarction? (Acute phase), immediately give oxygen, with vasopressors and other hormones and other treatment. ECG was reviewed after 1 hour: room rate was 112 beats / min, room rate was 41 to 60 beats / min, and there was sinus P wave down ventricular seizure for ventricular seizures, compared with the 7: SV1 wave was significantly lighter, ST segment elevation about 0.15 ~ 0.1mV, STV2, V3 down about 0.1 ~ 0.2mV, Ⅱ, Ⅲ