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风湿性心脏病(RHD)和冠心病(CHD)均是临床常见病,随着RHD的治疗进展,患者的寿命逐渐延长,RHD发生急性心肌梗塞(AMI)的患者并不少见,现结合文献和对RHD发生AMI的临床特点做一介绍。 临床资料 例1,男,58岁,发现心脏杂音30年,曾诊为“RHD”。一年前出现心前区疼痛,每次发作2～3分钟。本次因情绪激动突发胸骨后压榨性疼痛2小时入院。否认高血压、糖尿病史,吸烟30年。查体:血压16/12kPa,心律绝对不齐,HR96次/分,心尖部闻及舒张中、晚期隆隆样杂音,双肺底偶闻湿性罗音。ECG示:心房纤颤,I、aVL、V_(2～6)出现病理Q波,ST段弓背抬高CPK19.4单位(正常<3单位),胸片示二尖瓣型心脏。
Rheumatic heart disease (RHD) and coronary heart disease (CHD) are common clinical diseases. With the progress of RHD, patients’ life expectancy is gradually prolonged. Patients with acute myocardial infarction (AMI) with RHD are not uncommon. An overview of the clinical features of RHD with AMI. Clinical data example 1, male, 58 years old, found heart murmur for 30 years, has been diagnosed as “RHD”. Appears a year ago, precordial pain, each episode 2 to 3 minutes. The sudden excitement after the sudden onset of sternal pain in 2 hours admission. Denied high blood pressure, diabetes history, smoking 30 years. Examination: blood pressure 16 / 12kPa, heart rate is absolutely missing, HR96 beats / min, apical scent and diastolic, late rumble-like murmur, binocular even smell wet rales. ECG showed: atrial fibrillation, I, aVL, V_ (2 ~ 6) pathological Q wave, ST segment dorsal raised CPK19.4 units (normal <3 units), chest showed mitral valve heart.