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某,男,57岁,干部。因慢性胃炎治疗8个月来我院复查胃镜既往无心前区闷感及疼痛史,体力活动如常。检查前BP 16.0/10.6 kPa,P 80次/min,心(-)。FKG大致正常。取左侧卧位,插镜顺利。当镜端达十二指肠球部时,患者感心慌。出汗。迅速退镜除见窦部血管显露,有簿感外,余胃及食管未见异常。即嘱患者平卧休息,BP 13.0/8.0 kPa,P 120次/min。听诊心脏(-)。给O_2吸入。EKG为RBBB。舌下含硝酸甘油,静点低分子右旋糖酐。3h后EKG示急性前间壁心肌梗塞并RBBB。心率80次/min,闻及室性早搏7～9次/min。给心电监护,利多卡因,杜冷丁及极化液等治疗。LDH580u,LDH_1>LDH_2,CPK正常。至第3天病情稳定,偶闻室性早搏。给口服慢心律,静点极化液10天后,EKG示急性前间壁心梗衍变过程,RBBB消失。住院40天出院。
A, male, 57 years old, cadre. Chronic gastritis due to treatment of 8 months to review our hospital gastroscopy in the past without prior heart mucus and pain history, physical activity as usual. Before the test BP 16.0 / 10.6 kPa, P 80 beats / min, heart (-). FKG roughly normal. Take the left lateral position, insert the mirror smoothly. When the mirror reaches the duodenal bulb, the patient feels panicked. Sweating. See in addition to quickly see the sinus vascular revealed, there is a sense of the book, I stomach and esophagus no exception. That Zhu Huanzhu supine rest, BP 13.0 / 8.0 kPa, P 120 times / min. Auscultation heart (-). Inhaled O_2. EKG is RBBB. Sublingual nitroglycerin, intravenous low molecular weight dextran. After 3h EKG showed acute anterior myocardial infarction with RBBB. Heart rate 80 beats / min, smell and ventricular premature beats 7 to 9 beats / min. To ECG monitoring, lidocaine, pethidine and polarization solution treatment. LDH580u, LDH_1> LDH_2, CPK normal. To the first three days of stable, occasionally heard of ventricular premature beats. To oral slow heart rate, static point solution 10 days later, EKG showed acute anterior myocardial infarction evolution, RBBB disappeared. 40 days hospital discharge.