Mathen Pratheesh George, Ghosh Gopal Chandra, Thomson Viji Samuel
Department of Cardiology, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India.
Heart Asia. 2019 Feb 23;11(1):e011156. doi: 10.1136/heartasia-2018-011156. eCollection 2019.
A 58-year-old man presented to the chest pain unit with crescendo angina over 24 hours and worsening dyspnoea of 10 hours duration. He was a known diabetic and hypertensive on regular treatment for 10 years and a habitual smoker with over 15 pack-years smoking duration. Examination revealed a profusely diaphoretic and dyspnoeic (respiratory rate of 45/min) individual with a blood pressure of 100/60 mm Hg and heart rate of 124 beats/min. He was hypoxic and his oxygen saturation in the ambient air was 64%. His jugular venous pressure was elevated with a prominent V wave. Cardiovascular examination revealed a harsh grade IV/VI systolic murmur over the lower left parasternal border. There were bilateral extensive crepitations heard over the lung fields. ECG on admission revealed presence of Q wave and ST elevation in leads II and III, aVF with ST depression in I and aVL. X-ray chest showed normal cardiac shadow and features of grade III pulmonary venous hypertension. Transthoracic echocardiography is shown in figure 1.Figure 1Transthoracic echocardiogram short axis view at mid cavity level, 2D (A) and colour Doppler (B) image.
?A. Left ventricular (LV) true aneurysmB. LV pseudoaneurysmC. LV pseudo-pseudoaneurysmD. Ventricular septal rupture (VSR)E. LV free wall rupture.
一名58岁男性因24小时内进行性加重的心绞痛及持续10小时且逐渐加重的呼吸困难就诊于胸痛单元。他是一名已知的糖尿病患者和高血压患者，规律治疗10年，是一名有超过15包年吸烟史的习惯性吸烟者。体格检查发现该患者大汗淋漓、呼吸困难（呼吸频率45次/分钟），血压100/60 mmHg，心率124次/分钟。他存在低氧血症，在室内空气中的氧饱和度为64%。其颈静脉压升高，有明显的V波。心血管检查发现左胸骨旁下缘有粗糙的IV/VI级收缩期杂音。双肺野可闻及广泛的湿啰音。入院时心电图显示II、III、aVF导联有Q波和ST段抬高，I和aVL导联有ST段压低。胸部X线显示心脏阴影正常及III级肺静脉高压的表现。经胸超声心动图如图1所示。图1经胸超声心动图中腔水平短轴视图，二维（A）和彩色多普勒（B）图像。
？A.左心室（LV）真性动脉瘤
B.左心室假性动脉瘤
C.左心室假假性动脉瘤
D.室间隔破裂（VSR）
E.左心室游离壁破裂。
