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Abstract: The patient reported that he started to have chest tightness and shortness of breath 2 years ago without any obvious cause, which was significantly aggravated after activity and sometimes improved after rest, but it tended to recur. 3 days ago, the patient’s symptoms worsened without any obvious cause, and he came to our hospital promptly, and was diagnosed as tachycardia after related examination, and was given a single-chamber cardiac defibrillator implantation, and the symptoms of chest tightness and shortness of breath were relieved after medication.
Basic information】Male, 62 years old
Disease Type】Tachycardia (ventricular tachycardia)
Hospital】Third Xiangya Hospital of Central South University
Date of consultation】January 2022
Treatment plan】Surgical treatment (single-chamber cardiac defibrillator implantation) + intravenous infusion (cefuroxime sodium for injection) + oral medication (clopidogrel sulfate tablets, metoprolol succinate extended-release tablets)
[Treatment period] 12 days of hospitalization, long-term follow-up
Treatment effect] The symptoms of chest tightness and shortness of breath disappeared and the condition was stable
I. Initial consultation
The patient reported that he began to experience chest tightness and shortness of breath 2 years ago with no obvious cause, which was significantly aggravated by activity and sometimes improved after rest, but was prone to recurrent attacks. He was treated in our hospital in 2019 and diagnosed with coronary atherosclerotic heart disease, ischemic cardiomyopathy, and old myocardial infarction. 1 year ago, he was diagnosed with chronic heart failure and discharged after symptomatic treatment. 3 days ago, the patient had chest tightness and shortness of breath with palpitations again without any obvious cause, and came to our hospital for further diagnosis and treatment. Cardiac ultrasound showed left heart enlargement, diffuse weakening of left ventricular wall motion and acoustic changes of ventricular wall tumor formation; ECG showed wide QRS wave group tachycardia, and the preliminary diagnosis was tachycardia (ventricular tachycardia), and the patient was admitted to hospital for treatment.
II. Treatment history
After the patient was admitted to the hospital, he was informed of his condition. Due to the relative severity of ventricular tachycardia, a single-chamber cardiac defibrillator implantation was required after comprehensive consideration, and the patient’s consent was obtained. Under local anesthesia, an incision of about 6 cm was made in the left upper chest, and a single-chamber cardiac defibrillator was implanted to treat the heart disease. Postoperatively, cefuroxime sodium for injection was given intravenously for anti-infection treatment. Oral metoprolol succinate extended-release tablets were given to slow down the heart rate, and clopidogrel hydrogen sulfate tablets were used to provide antiplatelet and prevent postoperative thrombosis. Regular oral administration of the above drugs was continued after discharge.
III. Treatment effect
The operation went smoothly, with no significant abnormalities in blood pressure and heart rate, and the patient returned to the ward safely. At 8 days of hospitalization, the symptoms of chest tightness and shortness of breath had improved. After 12 days of hospitalization, all the patient’s symptoms disappeared, and he could sleep flat at night, and his general condition was acceptable. On examination, there was no elevation in the precordial area, the left side of the heart border was enlarged, the apical pulsation was located at 1.0 cm outside the left midclavicular line at the 6th intercostal space, the heart rhythm was uniform, and the heart rate was 72 beats/min. On comprehensive consideration, the patient could be discharged home to recuperate, and then adhere to the medication and follow up promptly if there was any discomfort.
IV. Notes
I was happy to see that the patient’s condition had improved and he was happily discharged from the hospital, and I advised the patient to pay attention to the following points after going home.
1. Establish a good diet, choose a low-salt, low-fat, low-purine diet, abstain from smoking and alcohol, pay attention to rest, avoid exertion, cold, infection, and emotional excitement.
2. Self-monitoring of blood pressure and heart rate, regular rechecking of blood routine, liver and kidney function, cardiac enzymology, electrolytes, electrocardiogram and cardiac ultrasound.
3, pay attention to the side effects of drugs, if there are abnormalities such as heart rate <60 beats/min, blood pressure <90/60mmHg, abnormal bleeding, hematuria, black stool, skin petechiae, etc., seek medical attention promptly.
V. Personal insight
The treatment of tachycardia mainly includes medication and surgery, the specific treatment method depends on the condition, when the condition is mild, the condition can be controlled by taking medication regularly. If the condition is serious, as in the case of this patient, simple medication is not effective and surgical treatment should be performed. This patient was actively treated with single-chamber defibrillator implantation and the condition was better controlled with the combination of medication after surgery. Therefore, once symptoms such as chest tightness, shortness of breath, palpitations and other discomfort occur, standardized treatment should be carried out to avoid delaying the disease.