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1 病历简介 患者,女,42岁。门诊于2000年1月14日晚以“急性左心衰”收入心内科。该患2年前常自觉乏力、活动后气短。20天前突然出现心悸、呼吸困难、夜间不能平卧、头晕、黑蒙等症状。曾在外院住院,以“冠心病、急性左心衰”治疗10天效果不明显,故急诊转入我院。入院查体:Bp:90/70mmHg、神经志清、呼吸促、端坐位、口唇发绀、轻度贫血外观、颈静脉无怒张。HR107次/分;节律正,心尖部S_1尚有力,各瓣口杂音(-),左下肺可闻及少量湿性罗音。腹软,双下肢无浮肿。ECG:窦速,ST-T正常。急检血常规:WBC:10800/mm~3、Hb:110g/L、PLT25万/mm。床头心动超声示:LA轻度增大(34mm),左房内可见3.0×2.0cm大小一椭圆形回声团块,表面光滑,边界清楚,以蒂附着于房间隔下方。该团块可随血流运动,当心室舒张时,部分瘤体随血流通过二尖瓣口而凸入左室,使二尖瓣口阻塞;而当心室收缩时,二尖瓣口关闭,瘤体嵌顿在二尖瓣环口处。结合病人典型左心衰临床表现及特异性超声心动图所见,诊断为“左房粘液瘤”。内科纠正心衰治疗效果不佳,于次日晨精心外科手术摘除,病理诊断
1 medical records patient, female, 42 years old. Outpatient clinic on January 14, 2000 night with “acute left heart failure” income cardiology. The patient often feel tired 2 years ago, shortness of breath after the event. 20 days ago sudden heart palpitations, dyspnea, supine can not be at night, dizziness, dark and other symptoms. Had hospitalized outside the hospital, with “coronary heart disease, acute left heart failure,” the effect of treatment for 10 days is not obvious, so the emergency department transferred to our hospital. Admission examination: Bp: 90 / 70mmHg, nervous, breathing, sitting, lips cyanosis, mild anemia appearance, jugular vein without tension. HR107 beats / min; rhythm is positive, apical S_1 still powerful, the valve noise (-), the lower left lung can smell a small amount of wet rales. Abdomen soft, no swelling of both lower extremities. ECG: sinus speed, ST-T normal. Urgent blood test: WBC: 10800 / mm ~ 3, Hb: 110g / L, PLT25 million / mm. Bedside echocardiogram showed: LA slightly increased (34mm), the left atrium visible 3.0 × 2.0cm size of an oval echo mass, the surface is smooth, clear boundary, pedicle attached to the septum below. The mass flow with the blood flow, when the ventricular diastolic, part of the tumor with blood flow through the mitral valve and protruding into the left ventricle, the mitral valve obstruction; and when the ventricular contraction, the mitral valve mouth closed, Tumor incarcerated at the mitral valve annulus. Combined with the typical clinical manifestations of patients with left heart failure and echocardiography seen, diagnosed as “left atrial myxoma.” Medical correction of heart failure treatment ineffective, careful surgical removal the next morning, pathological diagnosis