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患者女,50岁,一年前出现畏热、多汗、失眠、易激动、多食、便溏,渐消瘦。近一个月来心悸、胸闷、黑噱。查体:血压160/80,两眼轻突,甲状腺轻度肿大,有血管杂音,指颤,周围血管征(+),基础代谢率+37%。心电图:偶发房性早搏,诊为甲亢并房早。于1987年元月19日住院。口服心得安10mg每日8次,房早消失,后因突然停药出现频发房早再次使用,心律转为正常。连服21日出现轻度窦缓,第2次停药约40小时许,突感心悸、头晕,黑朦、胸闷,血压由发作前130/80骤升至164/96,急描心电图,窦性心律同时伴短阵房速合并窦性停搏。即予心得安10mg口服,3小时后再服10mg约2小时恢复窦性心律,血压降至144/86,症状缓解。采取每日减量7.5mg,6日后停用心得安,无心律失常再发生。后经食道心房调搏测定窦房结功能:SCL1000ms,SNRT1620ms CSNRT600ms,SACT180ms,IHR760ms。临床诊断:
Female, 50 years old, a year ago, fever, sweating, insomnia, irritability, more food, loose stools, weight loss gradually. Nearly a month to heart palpitations, chest tightness, black stunt. Physical examination: blood pressure 160/80, two sudden process, slightly enlarged thyroid, vascular murmur, tremor, peripheral vascular sign (+), the basal metabolic rate of 37%. ECG: sporadic atrial premature beats, diagnosed as hyperthyroidism and room early. In January 19, 1987 was hospitalized. An oral experience of 10mg 8 times a day, room disappeared early, due to sudden withdrawal appeared frequent room early again, heart rate turned normal. Even with mild sinus on January 21, the second withdrawal of about 40 hours Xu, sudden heart palpitations, dizziness, darkness, chest tightness, blood pressure rose sharply from the pre-episode 130/80 to 164/96, emergency ECG, sinus Ventricular tachycardia accompanied by a short-term atrial tachycardia sinus arrest. That is, propranolol 10mg orally, 3 hours and then serving 10mg for about 2 hours to restore sinus rhythm, blood pressure dropped to 144/86, the symptoms ease. Take a daily reduction of 7.5mg, 6 days after the withdrawal of propranolol, no arrhythmia recurrence. After transesophageal atrial pacing determination of sinus node function: SCL1000ms, SNRT1620ms CSNRT600ms, SACT180ms, IHR760ms. clinical diagnosis: