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患者男性,31岁,因低热、胸闷、心悸来我院就诊,10d前有明确的感冒病史,入院查体:T37.5℃,HR72次,律不齐,心尖部S_1低,并可闻及Ⅱ级SM吹风样杂音,双肺呼吸音稍粗。WBC12.7×10~9/L,N0.7,L0.3,ESR 25mm/1h。胸片:心影横径稍扩大。M型超声心动图提示左室内径54mm,室壁运动稍差,EKG描记见附图,临床拟诊:心肌炎。EKG分析(图见76页):上下两行为同次Ⅱ导联记录,窦性P—P间距为0.80～0.88s,窦性心律基本均齐。同时可见一组期前发生的P波,其形态多变,均能下传心室与前窦性心室激动联律间距不等(0.35～0.58s),可能为多源性房性早搏(简称房早)。房早后出现室性异位心律,QRS波群呈左束支阻滞图形,如R6、10、11、14、15、18、19、22 23、27、33,初看上去似为房早后出现室性逸搏心律,但经分析可除外这种情况。因第2行中第
Male, 31 years old, because of fever, chest tightness, heart palpitations to our hospital, 10d before a clear history of influenza, admission examination: T37.5 ℃, HR72 times, irregular, apex S_1 low, and can be heard Class Ⅱ SM hair style noise, breath sounds slightly thick lungs. WBC12.7 × 10 ~ 9 / L, N0.7, L0.3, ESR 25mm / 1h. Chest X-ray: slightly enlarged heart shadow diameter. M-mode echocardiography prompted left ventricular internal diameter 54mm, wall motion slightly worse, EKG tracings see the attached chart, clinically diagnosed: myocarditis. EKG analysis (see page 76): Up and down the two records with the same second lead, sinus P-P spacing of 0.80 ~ 0.88s, sinus rhythm are basically homogeneous. At the same time, we can see a group of pre-P wave, its morphological changes, can be downloaded ventricular and anterior sinus ventricular activation distance ranging (0.35 ~ 0.58s), may be multi-source atrial premature beats early). Room early occurrence of ventricular ectopic rhythm, QRS complex was left bundle branch block pattern, such as R6,10,11,14,15,18,19,22 23,27,33, at first glance seems to be room early Ventricular atrial rhythm occurs after, but the analysis can be excluded except this situation. For the second row in the first