[SCD-FORUM] 82E RE:病例：男性 29岁――Fontaine医生写给朱医生的

[SCD Symposium]

82E RE:病例：男性 29岁――Fontaine医生写给朱医生的
亲爱的朱医生
     这是个有趣的病例。在这样的病例中知道室速起 
源的可能部位较重要。室速的形态都相同吗？如果室 
速起源于左室，那么可能是心肌炎导致。如果室速起 
源于右室，那么可能是致心律失常性右室发育不良或 
者为心功能尚好的特发性扩张型心肌病。因此，重要 
的是能更好的描述心肌炎的临床表现，有多严重？其 
他重要之处是要了解常规心脏超声是否显示心功能下。
Guy Fontaine 医生

Sergio Dubner医生
科委会主席

Edgardo Schapachnik医生
组织会主席
袁奕译 王玲洁校


82E RE: Case: Male, 29yrs. Dr. Fontaine to Dr. Zhu
Dear Dr Zhu

Interesting case. In such a case it is important what is the probable
site of origin of VT ? Is the VT always of the same morphology ?

If VT originates in the left ventricle it is probably the result of
Myocarditis If VT originates in the RV it is probably a case of ARVD  
or IDCM with  preserved cardiac function.

Therefore it is also important to have a better description of the
clinical expression of myocarditis. How severe it was?

It is also important to know if regular echo showed a decrease in
cardiac function.

Guy Fontaine MD PhD

--
Dr. Sergio Dubner
President of Scientific Committee

Dr. Edgardo Schapachnik
President of Steering Committee

>
> 病历：男 现年29岁
> 8岁感冒后出现早搏诊断为病毒性心肌炎；此后早搏
> 一直存在，并有右室大。
> 19岁第一次室速发作，持续时间3分钟后自行恢复，伴
> 随症状有黑蒙。之后两三年一直无发作。
>      21岁第二次发作，持续时间长达2~3小时，开始无
> 明显症状，两小时后心慌，虚汗，随即昏厥几分钟，
> 后静脉注射心律平转律。此后曾口服心律平但无效。
> 22~23岁期间曾于大连医科大学附属一院杨延宗教授处
> 实施两次射频消融手术，均因诱发不成功而失败。第
> 二次手术同时实施了心内膜活检证明为心肌病。
> 23~26岁期间未用药，室速间歇发作，每次几秒钟至几
> 十分钟不等，均可自行恢复或去医院静脉注射心律平
> 几分钟后即可恢复。深夜至凌晨发作较频繁。在这几
> 年中整体规律为某一时间段集中发作（两次在冬
> 季），此后可自行稳定几个月或更长时间。作为大学
> 生，研究生患者喜好长跑，打球等剧烈运动，而运动
> 中从无发作，至今患者的任何体力活动不受限制。
> 27岁即2004年口服心律平预防有效，心律平150mg bid　或
> tid。服用1~2个月停药后可稳定0.5~1.5年。
> 去年至今一直口服心律平无法停药，停药则发作频
> 繁。目前为早200mg，晚150mg，低于此剂量即会发作。
>
>      对这位患者目前的情况有何治疗建议？
> 宁 朱 <dyeyxnk在yahoo.com.cn>
>
> -----------------
>
> Case: Male, 29yrs
>
> Illness history: Viral myocarditis was diagnosed based on premature
> ventricular contractions (PVCs) at age 8 after an influenza attack.
> Since then, PVBs never disappeared and right ventricle enlargement
> had been noticed.
>
> ECG revealed VT lasting 3 minutes at age 19, accompanied with
> faintness. After 2-3 years, no VT reoccurred.
>
> The second VT episode was recorded at age 21 lasting 2-3 hrs
> accompanied with syncope. Intravenous propafenon worked. Oral
> administration of propafenon could not prevent the patient from VT
> attack.
>
> RFCA for VT had been delivered twice at age 22~23 by Pro. Yang at the
> first affiliated Hospital of Dalian medical university. During RFCA,
> VT could not be induced and cardiomyopathy was diagnosed by
> endocardiac biopsy.
>
>
> VTs occurred intermediately lasting several seconds to a few minutes.
> VT restored to sinuous rhythm either spontaneously or by intravenous
> propafenon administration. VT usually occurred at midnight or early
> morning. At the following years, Sometimes VT occurred quite often
> during a certain period (for example: twice attacks in Winter), and
> then no occurrence for several months or even longer time. The
> patient enjoys doing exercise. No VT attacked during exercise. No
> restriction to exercise.
>
> Since 27 yrs old (2004), propafenon has been administrated in the
> doses of 150mg bid or tid. Drug quitted after 1-2 months
> administrations, keeping no VT attack for 0.5-1.5 yrs.
> Since last year, the drug cannot be quitted, otherwise VT reoccurred.
> So far, the doses of the drug are 200mg at early morning and 150mg at
> night. Lower dosages may not prevent the VTs.
>
> Any suggestion about the treatment?
>
> Zhu <dyeyxnk在yahoo.com.cn>.