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患者男,54岁。因活动后气促半年,反复晕厥3次入院。体检:R20次/min,口唇微绀。心界不大,心率86次/min,律齐,心音低,无杂音。两肺呼吸音略低,无啰音。神经系统无殊。X线胸片示两下肺纹理模糊。入院时心电图(附图A)示窦性心律,电轴右偏,V_1—V_3T波倒置。入院诊断:冠心病。住院后次日阿-斯综合征发作,心电监护示窦停→室上速→短阵室速→室性逸搏。经抢救恢复窦性心律(附图B)S_1加深,R_(aVR)升高,R_(aVF)顶端有错折。V_1由入院时的rS型变为qR型,顺钟向转位。1天后心电图(附图C)显示S_ⅠT_Ⅲ改变,电轴+110°,V_1呈qRs型,ST_(v_1—v_3)水平型下移0.1—0.2mV,T波对称倒置加深。1周后心电图(附图D)示S_Ⅰ变浅,电轴+80°,T_(Ⅲ)直立。V_1呈rS型,T_(v_1—v_3)倒置变浅,与入院时相仿。肺通气-灌注扫描及肺动脉造影证实为急性肺栓塞。
Male patient, 54 years old. Six months after the event due to shortness of breath, repeated three episodes of syncope admitted to hospital. Physical examination: R20 times / min, micro-cyanotic lips. Heart, heart rate 86 times / min, law Qi, low heart sound, no noise. Breath sounds slightly lower lungs, no Alar. Nervous system without special. X-ray showed two lungs blurred texture. Admission electrocardiogram (A) shows sinus rhythm, right axis deviation, V_1-V_3T wave inversion. Admission diagnosis: coronary heart disease. On the next day after hospitalization, Alzheimer’s syndrome attack, ECG showed sinus stop → supraventricular tachycardia → VT → ventricular escape. After rescue and restoration of sinus rhythm (Figure B) S_1 deepened, R_ (aVR) increased, R_ (aVF) tip error. V_1 changed from rS to qR on admission, translocating clockwise. One day later, electrocardiogram (Fig. C) showed that S_ⅠT_Ⅲ changed, axis + 110 °, V_1 showed qRs type, ST_ (v_1-v_3) level shifted 0.1-0.2 mV horizontally, and T wave deepened symmetrically. Electrocardiogram after 1 week (Figure D) showed S_Ⅰ was shallow, the axis of +80 °, T_ (Ⅲ) upright. V_1 was rS type, T_ (v_1-v_3) inverted shallow, similar to admission. Pulmonary ventilation - perfusion scan and pulmonary angiography confirmed acute pulmonary embolism.