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目的提高对心尖球囊样综合征合并哮喘的临床特征、诊断和治疗的认识。方法和结果患者为73岁女性,有哮喘病史10年,反复胸闷4年,咳嗽伴胸闷半个月,胸痛7h入院。行急诊经皮冠状动脉介入术(PCI),术中冠状动脉造影示前降支近中段第一对角支分出后主支狭窄约40%,其余血管未见明显狭窄;左室造影显示心尖呈球囊样。超声心动图检查示左室射血分数(EF)为35%。诊断为心尖球囊样综合征合并哮喘。经对症治疗后心功能逐渐恢复。结合文献,表明心尖球囊样综合征与急性心肌梗死鉴别困难,而治疗和预后相距甚远;心尖球囊样综合征合并哮喘发作急性左心衰时,与肺源性哮喘鉴别较困难,治疗迥异。结论临床工作中应提高对心尖球囊样综合征的认识,注意鉴别诊断,制定正确的治疗方案。
Objective To improve the clinical features, diagnosis and treatment of apical balloon-like syndrome with asthma. Methods and Results Patients were 73-year-old female, had a history of asthma 10 years, repeated chest tightness for 4 years, cough with chest tightness for half a month, chest pain 7h admission. Emergency percutaneous coronary intervention (PCI), intraoperative coronary angiography showed anterior descending branch near the first diagonal branch of the main branch of stenosis after about 40% of the remaining blood vessels showed no significant stenosis; left ventricular angiography showed apical Was balloon-like. Echocardiography showed a left ventricular ejection fraction (EF) of 35%. Diagnosis of apexular sac-like syndrome with asthma. After symptomatic treatment of cardiac function gradually restored. Combined with the literature, that apex balloon-like syndrome and acute myocardial infarction difficult to identify, but the treatment and prognosis are far apart; apex balloon-like syndrome with acute asthma attack of left heart failure, the identification of pulmonary asthma is more difficult to treat Different. Conclusions The clinical work should raise awareness of apex balloon-like syndrome, pay attention to the differential diagnosis and formulate the correct treatment plan.