Differential diagnosis of cardiac disease April 9, 1998, the Beijing Union Medical College Hospital heart medicine experts, Professor Ji Baohua, through the Guardian medical network - Union Medical College Hospital long-distance diagnosis centre, external assistance provided by the provincial hospital patients were long-distance consultations, from diagnosis to treatment of one by one And put forward their views. Published here, for the exchange. First, medical records Abstract: Female patients, 52-year-old, married, Han nationality, due to repeated chest tightness, palpitations more than six months, adding to two months of admission. Patients in September 1997 due to exertion or emotional after chest tightness, palpitations, shortness of breath, rest can be eased. The last two months, chest tightness, palpitations Obviously, in January 24 this year, his income homes, in the hospital was diagnosed as one. "Dilated cardiomyopathy and heart function III-class", 2. "Polymyositis." To "West to Portland, furosemide," such as medicine, the symptomatic treatment after symptoms eased slightly, with demand for a clear diagnosis, in the March 16, 1998 transferred to our hospital. Previous history: In 1995, the muscle biopsy, diagnosis as "polymyositis" in September of that year found that the frequency of the electrocardiogram of the room as early as Bo. Polymyositis has been used by one month the "strong pine" treatment (30 mg / day dose, after the gradual reduction). On the Green, streptomycin allergies. Investigations of: T 36.5. Ο C P 89 times / sub-R 18 / min BP 18/12 kpa. Clear consciousness, filling jugular vein, two in the lung and a little moist Luo Wen-heart on both sides of industry to expand to the left significantly, heart rate 89 times / points, missing law, it is the early 7-8 Bo / min, Wen and the apex District II-III-class systolic murmur. Abdominal soft, referring to the liver in Leixia 3, under 5 that Jiantu, quality, light tenderness, liver - levy suspicious neck back positive, both lower extremities mild swelling. Supplementary examination: blood: WBC10.4 G / LN 54%; echocardiography: the increase of the left, left slightly increased, the lower left ventricular function, mitral, tricuspid a small number of anti-flow; electrocardiogram: sinus Rhythm, not entirely left bundle branch block, multi-derived rooms as early as the frequency of clinical cardiomyopathy electrocardiogram changes; chest X-rays: Shuangfei door shadow increased heart rate increased significantly, the left and right ventricle increase ; Abdominal CT scan: hepatomegaly; chest CT scan: left ventricle increased Holter: sinus rhythm, the frequency of the RUF as early as the speed and shorter, more frequent source of long and short-room array ventricular tachycardia, indoor Block; limb muscle biopsy: the number of myocarditis; myocardial enzymes: LDH 493 U / L, α-hydroxybutyric acid dehydrogenase 526 U / L, CPK 2000至3085 U / L (normal: 195 U / L), CK-MB: 106 U / L. Preliminary diagnosis: 1. Dilated cardiomyopathy, frequent premature ventricular contractions, heart failure (cardiac function Ⅱ - Ⅲ level); 2. Polymyositis. Therapeutic Use: enteric-coated aspirin 100 mg qd, Chino of 0.2 Bid, Rachel Yan Lok 100 mg Bid, phenytoin 0.1 Tid, polarization treatment. Second, Professor Ji: 1. Echocardiography said the left atrium, may I ask specific numerical » (Answer: 46 mm); 2. Let me see if chest X-ray » (The scene to produce X-rays) Third, Professor Ji-site analysis: Review of the patient's medical history and check all kinds of information, I think that is not consistent with the disease, "Dilated cardiomyopathy." First of all, the heart is not in line with increasing extent, heart shape from the X-ray view does not increase significantly, from echocardiography, left the increased value of only 46 mm (normal is about 40 mm), the increase was not obvious , And the left ventricle is also only slightly increased. Dilated cardiomyopathy is多见committed to expand and extend the very obvious, particularly the left ventricle is more obvious. In addition, dilated cardiomyopathy is unknown cause of heart disease, the diagnosis prior to the next, we should first rule out the possible existence of the various risk factors. Patients with a connective tissue disease - the existence of polymyositis. Spectrum from the muscle of view, CPK (creatine phosphokinase) from 2000 mg / L to 3085 mg / L (normal value of 195 m g / L below) and muscle biopsy support, patients have systemic symptoms of muscle pain, Note also multiple myositis activities. Polymyositis can myocardial involvement, can cause heart failure and cardiac different degrees of expansion. Therefore, the patient should first take into account the secondary cardiomyopathy may be, that is secondary to polymyositis. Therefore, the first treatment to control the disease. Treatment: consider the use of corticosteroid control polymyositis. For the treatment of heart failure, I think that you now use a single too. You now only awarded welcomed the music, this is nitrate drugs for anti-heart failure are performing poorly. General would also like to combine anti-α1-adrenergic receptor drugs, or anti-angiotensin-2 enzymes convert the drug, so not only reduces heart before the load, can reduce the load after; proper use of diuretics, also reduce the burden of heart Necessary; digitalis drugs can also be appropriate to use, comprehensive anti-congestive heart failure. Anti-arrhythmia, in general do not advocate using phenytoin, the drug digitalis poisoning for many patients, but also a 1000 mg / first day of the next day, 500 mg; while you are 100 mg 3 / day, the dose is clearly not enough. Propose to you for using propafenone, triethylamine iodine-skin.
