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病例13-2018:一名患心肌病和复发性室性心动过速的53岁男性
Case 13-2018 — A 53-Year-Old Man with Cardiomyopathy and Recurrent Ventricular Tachycardia


Joshua C. Ziperstein ... 心脑血管疾病 • 2018.04.26

病例陈述


Timothy W. Churchill医师:一名53岁男性由于治疗非缺血性心肌病的除颤器植入后出现休克和复发性室性心动过速而被收入本院。

本次入院前的4周,患者正在加勒比地区度假,此前他的健康状况一直正常。当时他的妻子在凌晨注意到他反应迟钝、发出“汩汩”声并出汗。他醒来后报告出现胸痛、心悸和头晕。患者由救护车送往当地一家医院,在该医院经检查心率为65次/分,血压为100/56 mmHg,他通过鼻插管吸氧量为2 L/min时氧饱和度为100%。肌钙蛋白T水平为1.56 ng/mL(正常范围,<0.01 ng/mL),乳酸水平为1.9 mmol/L(17 mg/dL;正常范围,0.5~1.6 mmol/L [5~14 mg/dL])。全血细胞计数以及电解质、镁、钙和淀粉酶的水平均正常,肾功能和甲状腺功能检查结果也正常。D-二聚体水平未检出。患者在这家医院就诊时,出现了单形性室性心动过速,心率达201次/分;通过心脏电复律转复为窦性心律。施用了阿司匹林、氯吡格雷、依诺肝素、瑞舒伐他汀、胺碘酮和替罗非班。通过空运将患者转诊至佛罗里达州的一家医院。





作者信息

Joshua C. Ziperstein, M.D., Timothy W. Churchill, M.D., Sandeep S. Hedgire, M.D., G. William Dec, M.D., and James R. Stone, M.D., Ph.D.
From the Departments of Medicine (J.C.Z., T.W.C., G.W.D.), Radiology (S.S.H.), and Pathology (J.R.S.), Massachusetts General Hospital, and the Departments of Medicine (J.C.Z., T.W.C., G.W.D.), Radiology (S.S.H.), and Pathology (J.R.S.), Harvard Medical School — both in Boston.

 

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