卢彦娜,唐群中,唐强

    (北京大学首钢医院心血管内科,北京 100144)

    1 临床资料

    患者男,80岁,主因“间断心悸1周”于2022年4月17日入住北京大学首钢医院心血管内科。患者入院前1周开始间断出现夜间如厕后心悸,无明显胸闷、胸痛,持续时间长短不一,数分钟至数小时不等,门诊以心悸待查收入院,既往高血压、陈旧性脑梗死病史。个人史、婚育史、家族史无特殊。入院查体:血压153/82mmHg(1mmHg=0.133kPa),体质量指数(body mass index,BMI)23.3kg/m2,心率70次/min,心肺腹查体未见明显异常。

    入院后心电监护提示阵发性心房颤动,心肌酶、N末端B型钠尿肽前体未见异常;心电图:窦性心律,肢体导联低电压趋势(图1A);超声心动图:射血分数59%,左室舒张末期内径48mm,左房前后径41mm,左房增大,左室肥厚,轻度二尖瓣返流。24h动态心电图:平均心率55次/min,窦性心动过缓伴不齐;经食道彩超提示左房及左心耳内未见血栓形成,有射频消融指征。

    图1 心电图动态变化Figure 1 Dynamic changes of electrocardiogramA: at admission, ECG showed sinus rhythm, limb lead low voltage trend; B: day of pulmonary vein isolation, ECG findings are consistent with admission; C: 2 d after pulmonary vein isolation, sinus rhythm, V4-V6 PR segment of lead ⅡⅢ aVF was depressed, and the concave upward elevation of ST segment; D: 48 d after pulmonary vein isolation, indicated sinus rhythm, low limb lead voltage, and ST-T changes; E: 53 d after pulmonary vein isolation, indicated sinus rhythm, low limb lead voltage, ST-T changes, and T-wave inversion deepened than before.ECG: electrocardiogram. ......