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Writing Wen | Medical Sea Picking
Sometimes the cunning disease is sometimes like an actor who is good at dressing up, which makes the diagnosis of the disease sometimes fog.The deep skill of practicing fire eyes is not overnight. This is also the professional characteristics of living from the doctor to the old learning.
Acute coronary syndrome?
Main complaint, current medical history: Patients, 52 years old, because of the "upper abdomen burning sensation for 2 days" Admitted to the hospital.患者无明显诱因出现上腹部烧灼感，伴大汗，感轻度心慌，时有咳嗽，无、胸闷、憋喘，无头痛、头晕，无腹痛、腹胀、 Diarrhea, dark stool, no fever, no black mask, unconsciousness, etc., the burning sensation of the upper abdomen, the symptoms of sweating will not be alleviated, and the electrocardiogram prompts Multi-guided ST-T change, urgently check the symbolic muscle injury logo Stepping, income courtyard with "acute coronary syndrome".
Previous, personal history: The body is general, there are "" History of "diabetes, hypertension", no history of hepatitis B and close contact, there is a history of "uterine fibroids" surgery, no history of external injuries, no history of blood transfusion, no history of allergies, and no history of tobacco and alcohol.
Physical examination: T 36.4 ° C, P 117 times/min, R 20 times/min, BP 113/87mmHg, generally the whole body, the whole body is humid, The skin temperature is low, the bilateral breathing is uniform, the breathing sound is clear, and there is no dry and wet.There is no abnormal bulge in the front area of the heart, no tremor, the heart is normal, the heart rate is 117 times/minute, the rhythm rules, the heart sound is powerful, no noise, no peripheral vascular signs.The abdomen is flat, no tenderness, no scaled pain, murphy ’s is negative, and both lower limbs are not swollen.
Test returns:
Cassivan kinase homogeneous enzyme 69.70NG/ml (0.6-6.3),, 0.6-6.3),, 0.6-6.3),, 0.6-6.3)肌红蛋白97.70ng/ml（1.5-70），肌钙蛋白I 6.190（0-0.03）；B型钠尿肽22300pg/ml（300-900）； 急查血气分析：pH 7.43，PO 2 106mmHg， PCO 2 34.30mmHg, K + 3.80mmol/L, Na + 140.0mmol/L, CL -104mmol/L, BE -1.7mmol/L, so 2 99.40%, LAC 1.7mmol/L, GLU 9.40mmol/L; drop Calcium original 0.46ng /ml; blood conventional+CRP: white blood cells 19.00 × 10 9 /L (3.5-9.5), red blood cell 5.13 × 10 12 /L (3.8-5.1), hemoglobin 165g /L (115-150), platelet platelets, platelet platelets 419 × 10 9 /L (125-350), neutral granulocytes percentage 83.90%(40-75), C reactive protein 23.90 mg /L (0-8); nail exercises, liver and kidney exercises, condensation conventional+D-D- There is no abnormality of the di gymnarian; 10.49mmol/L (3.9-6.1), total cholesterol 5.72mmol/L (0-5.18), cholesterol 3.68mmol/L (0-3.36 To.
Auxiliary examination:
ECG: Sinic tightness, v3 -6 Directors ST segment pressure is 0.1-0.2mv, and the II, AVF lead ST section is low (Figure 1).
Figure 1
Cardiac color Doppler ultrasound: Left room diastolic diameter 47mm, each room room The internal diameter measurement value is normal.The left ventricular contraction function is reduced, the room wall movement is filled with reduction, and the left ventricular ejection score is 28 %. The aortic valve, two -pointed, and three valve have not been explored and obvious reflective signals.
Severe myocarditis, acute heart failure?
The patients heart function decreased sharply, and the myocardial injury margin, white blood cells, and inflammation indicators increased. Severe myocarditis acute heart failure caused by viral infections, gives people immunoglobulin, oxybolic nylonic acid inhibitory inflammation, large doses of vitamin C, coenzyme Q10 to improve myocardial metabolism; August 28, 2020 28 Daily reviewing the heart ultrasonic heart function is better, and the left ventricular ejaculation score rose to 40 %. Considering the improvement of the condition.
perfecting the local uneven increase of the left room wall of the left room, the local signal of the left heart chamber wall of the heart base wall, lower wall cardiac perception, middle layer of the heart of the heart There is no abnormalities in myocardial irrigation (Figure 2, 3).During the hospitalization period, ECG monitoring found that patients had increased blood pressure at night, up to 185/106mmHg, and blood pressure gradually dropped to 96/52mmHg after 2 hours.After treatment, the patients condition improved after treatment.
Figure 2
Figure 3
Patients are admitted to the hospital!It was misdiagnosed
Patients have never developed the above symptoms after discharge.On May 1, 2023, patients were admitted to the hospital again after drinking cold water. The patients upper abdomen is discomfort, sweaty, panic, accompanied by nausea, vomiting, no chest pain and radiation pain, no chest tightness, asthma, no dizziness, headache, no heat The body is sweating.
ECG prompt sinuscardia; cardiac ultrasound prompt EF65%.
Admission to the hospital: T 36.5 ° C, P 107 times/min, R 18 times/min, bp 88/58mmmhg.
Test returns: Nailing, coagulation conventional+ D-Di-germ no abnormalities; sodium B-type urinary peptide 2274pg/ml (0-100) ; MB 11.00NG/ML (2-7.2), muscle red protein 74ng/ml (23-112), muscle calcium protein I 0.260ng/ml (0.01-0.023); calcium calcium Su Yuan
