胸悶、全身無力、心臟問題：是否需要立即治療？-心臟血管專科

胸悶，全身無力，心臟問題？

吳主任您好，小弟現年23歲，已有兩月左右胸悶感，已於兩間醫院分別做過 心臟超音波 壓力與重分布心臟管流 杜普勒氏彩色心臟血流圖 電腦斷層造影 極度踏車運動 攜帶式心電圖紀錄過去被其中一間檢查出患有WPW症候群 說目前沒發作沒辦法診斷 便沒有下文 但胸悶感持續反覆發作 最近胸悶感加上左胸左手臂內側些微悶痛 本身很容易緊張 想詢問主任以下報告是否有出現心臟等相關問題 因為還有段時間才回診想先知道結果 是否有立即性危險 測試運動心電圖時 護理師告知有不正常情況 叫我等醫生告知我... 以我目前情況很危險嗎?Purpose:1(V) Dx; 2( ) PTCA; 3( ) PTMV; 4( ) Drugs; 5( ) CABG; 6( ) Rehabilitation 7( ) Arrhythmia; 8( ) Screening; 9( ) Others Pre-excercise ECG: Blood Pressure: 117/79 Medications: ( ) Yes, (V) No Patient Fasting:( ) Yes, (V ) No Stage: Speed/Grade(MPH/Grade): (1.7/10) (2.5/12) (3.4/14) (4.2/16) (5./18) Minutes: 2’ 5’ 8’ R2’ R5’ Blood Pressure: 149/80 186/78 175/76 155/60 140/61 Minutes: Blood Pressure: / / / / / Exercise Terminated Because of: A.( )Maximal Effort F.(V)Dyspnea K.( )Chest tightness B.(V)90% Maximal Heart Rate Obtained G.( )Arrhythmia L.( )Can’t catch-up speed C.( )ST Segment Shift H.( )Leg Pain M.( )Exercise intolerane D.( )Chest Pain I.( )Hypotension N.( )Vasovagal Reponse E.( )Fatigue J.( )Dizziness O. Total Time:9’11’’ MHR X MSBP: 179X 186= 33294 Maximal Achieved Rate: 179 Maximal Predicated Rate:197 90% Predicated Rate: 177 製表者 : F104246 張瑋涵 INTERPRETATION OF EXERCISE ECG 1.( ) Normal ECG at maximal effort 2.( ) Normal ECG at submaximal(90%)predicated heart rate 3.( ) Normal ECG at ”inadequate” heart rate of 4.( ) Abnormal ST junction and segment elevated 5.(V) Abnormal ST segment depression: A.Downsloping mm B.Flat 1 mm V5 C.Upsloping mm (from j point to at least 0.08 seconds) 6.( ) Other(Speciafy) Comment: 1.( ) Positive 2.(V) Negative 3.( ) Inconclusive(specify) 4.( ) Complication(specify) 5.OtherReport: The Tl-201 myocardial perfusion SPECT study was performed with dipyridamole pharmacologic stress. Intravenous dipyridamole was administered at a rate of 0.1 42 mg/kg/min for 4 min. The administered dose was 8.2 ml (5mg/ml). The patient experienced headache/dizziness during the stress test, and the symptom was relieved by aminophylline. The Tl-201 myocardial perfusion SPECT study performed 5 mins after intravenous injection of Tl-201 and 4 hours later revealed homogeneous distribution of radioactivity in myocardium of LV in each study. The EKG-gated functional study showed: Stress LVEF=72%, Rest LVEF=68%. Stress defect: 12% of total myocardium Reversibility: 78% of total (LAD: 50%, LCX: 70%, RCA: 0%). Impression: - No evidence of myocardial infarction or ischemia.Report: Echo machine： Patient source： 【Atrium and Aortic Root】 AO (mm) = 29 LA (mm) = 31 【Left Ventricle】 IVS (mm) = 9 PW (mm) = 9 EDD (mm) = 50 ESD (mm) = 29 EDV (ml) = ESV (ml) = LV mass (g) = LVEF： by M-mode measurement：71 % LV Wall motion: Normal wall motion 【Right Ventricle】 TAPSE＝mm 【Diastolic function】 Mitral inflow　E/A：? （E/A ratio:） Septal E/e：； Lateral E/e：； 【Valve】 MS: nil; MR: nil; AS: nil; AR: nil; TS: nil; TR: nil; PS: nil; PR: nil; 【Other findings】 IVC diameter：mm with sniff collapse ＞ 50% Intracardiac vegetation： Pericardial effusion：None Intracardiac thrombus：No Congenital lesions：NoneConclusion: 1. No cardiac chamber dilatation 2. Normal LV systolic function with normal wall motion 3. Normal RV systolic function 4. Equivocal MV prolapseClinical information: a 23 Y/O man, progressive and intermittent chest pain for 2 days..CTA of aorta without and with IV contrast medium enhancement shows: Comparison: No available comparison study . 〈〈Findings in concern〉〉 1. No evidence of aortic dissection, intramural hematoma or peforated aortic ulcer. 〈〈Other Findings〉〉 1. No remarkable finding in liver, gallbladder, spleen, pancreas, bilateral adrenal glands and kidneys.2. No pancreatico-biliary tree dilatation. Portal veins and hepatic veins are patent.3. Patent main trunks of SMA and SMV without evidence of obstructive bowel or colon lesion.4. Clear mesentery and omentum. No ascites. No pneumoperitoneum.5. No enlarged lymph nodes in abdomen and pelvis.6. No active lesion in bilateral lungs. No pleural effusion.7. No definite bony destruction in the scannd field.. IMP: No evidence of acute aortic syndrome1.Basic rhythm is sinus rhythm. HR around 45~139 bpm, mean HR=87 bpm. 2.Minimal HR was 45 bpm at 05:48 due to sinus bradycardia. 3.Maximal HR was 139 bpm at 10:49 due to sinus tachycardia. 4.Rare APCs with total 5 beats. 5.No VPCs. 6. The patient’s diary events were related to sinus rhythm.