男,70岁,风湿性心脏病咳嗽、咳痰、胸闷、气短病例

2020-06-29 师医生 病例网

患者主因"咳嗽、咳痰3天,气短、胸闷4小时"入院;

[患者姓名]:
[患者年龄]:70
[性别]:男
[科室]:风湿骨病科

【主诉】

患者主因"咳嗽、咳痰3天,气短、胸闷4小时"入院;

【现病史】

患者于3天前着凉后出现咳嗽、咳痰,痰粘色白,伴纳差,活动时气短、胸闷(多年),夜间尚能平卧休息(需侧卧位),头晕,无发热、寒战,无睡眠中憋醒,无胸痛,无恶心、呕吐,无腹痛、腹泻,口服"咳必清片",上述症状无缓解,4小时前出现气短、胸闷,呈持续性,口服"速效救心丸"治疗,效差,为求进一步诊治来院。自发病以来,神志清,精神差,饮食差,睡眠可,二便未诉异常。

【既往史】

在某大型医院诊断"风湿性心脏病"多年;"心房颤动"4年;2014年09月份、2015年01分、2015年05月份因心衰反复住院治疗,期间(2015-05-10本院)心电图:心房纤颤,室性早搏,ST段呈缺血型变化,不完全性右束支传导阻滞。心脏彩超:风湿性心脏病联合瓣膜病变、全心大、二尖瓣大量返流、三尖瓣大量返流、主动脉瓣少量返流、肺动脉瓣少量返流,肺动脉高压、心包积液、左室收缩功能减低(EF17%)、运动幅度不协调、先天性心脏病、房间隔缺损(原发孔型);肝胆胰脾彩超:肝大、淤血肝、胆囊结石(多发)、胆囊炎、右侧胸腔积液。对"磺胺类"药物过敏;否认"糖尿病、高血压"病史;否认"结核、肝炎"等传染病病史;无重大外伤及手术史;否认输血史;否认食物过敏史;预防接种史不详。

【查体】

T:36.6℃,P:77次/分,R:19次/分,BP:160/90mmhg。神清,精神差,呼吸尚平稳,自动体位,查体合作。双瞳孔正大等圆,对光反射灵敏,口唇稍紫绀,伸舌居中,双侧颈静脉怒张,颈软无抵抗,气管居中,甲状腺不大。胸廓对称无畸形,两侧呼吸动度一致,无增强或减弱,语颤均等,双肺呼吸音粗,双肺低可闻及湿性啰音,心率85次/分,心律绝对不齐,心音强弱不等,脉搏短绌,各瓣膜听诊区均可闻及3级收缩期吹风样杂音。腹部平软,无压痛,无反跳痛及肌紧张,肝肋下约8cm,剑突下约3cm,脾未触及肿大,Murphy征(-),肝-颈静脉回流征阳性,腹叩鼓音,移动性浊音阴性,肠鸣音弱。双下肢小腿胫前部皮肤发暗、浅表静脉曲张,双下肢Ⅰ°指凹性水肿,四肢肌力5级,肌张力正常,双侧babinski征(-)。

【辅助检查】

心电图示:心房颤动、ST-T段改变。

【初步诊断】

1.风湿性心脏病慢性心力衰竭(急性加重)心功能3级2.支气管炎3.心律失常心房纤维性颤动(心房纤颤)4.冠状动脉粥样硬化性心脏病5.静脉曲张(双下肢)

【鉴别诊断】

急性心包炎:可有较剧烈而持久的心前区疼痛,与发热同时出现,呼吸和咳嗽时加重,早期既有心包摩擦音,全身症状一般不如心肌梗死严重;心电图除aVR外,其余导联均有ST段弓背向下的抬高,T波倒置,无异常Q波出现。

【诊治经过】

入院后给予中医科护理常规、Ⅰ级护理,低盐低脂饮食,测血压、氧气吸入,心电监测、动态血压检查、呼吸功能监测、血氧饱和度监测;治疗上给予静点"硝酸甘油、丹参注射液、西咪替丁"以减轻心脏负荷、改善心脏微循环、保护胃黏膜及对症支持治疗,密切观察病情变化。 风湿性心脏病简称风心病,是指由于风湿热活动,累及心脏瓣膜而造成的心脏瓣膜病变,该患者是风心病并发心力衰竭,要以减轻心脏负荷、改善循环为主;平时要劳逸结合、预防感染、合理饮食来预防病情发作。

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    2020-06-29 医鸣惊人

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心脏对于人的重要性不言而喻,可对于温州的潘大爷来说,这十几年,他过得并不轻松。由于罹患风湿性心脏病,潘大爷被医生形象地形容为 “老天关闭了两扇心门 ”,然而不久前,在江苏省人民医院(南京医科大学第一附属医院)内外科团队联手开展的杂交消融手术治疗下,成功为潘大爷心脏“ 开了一扇小窗 ”。

风湿性心脏病患者术后应该注意什么?

风湿性心脏病(简称风心病)属于常见的心脏病,也是一种慢性病,因此,必须做好长期抗战的准备。

JAHA:风湿性心脏病的流行病学研究

在新苏格兰的人群中,9岁和10岁时风湿性心脏病(RHD)的患病率为0.9%至1%,16岁时的发病率可能会更高,但是尚未调查确证。

心内科会诊难题:抗凝时出现脑出血,该怎么办?

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Int J Cardiol:循环细胞因子可预测风湿性心脏病严重程度

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风湿性心脏病合并左房黏液瘤超声表现1例

患者女,47岁,因活动后心慌,胸闷10余年,加重2个月入院。体格检查:生命体征正常,心尖搏动有力,位于左锁骨中线,律齐,胸骨左缘第二三肋间心浊音界向左扩大,二尖瓣听诊区可闻及Ⅱ/6级舒张中晚期隆隆样杂音,左侧卧位时更加明显,主动脉瓣第二听诊区可闻及叹气样、递减型舒张期杂音,向胸骨左下方和心尖区传导,P2增强,余瓣膜未闻及病理性杂音,心尖区舒张期轻度震颤,左侧卧位明显。