临床病例讨论(汇总)

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1、CasestudiesforcardiovasculardiseaseCase1History:Aten-year-oldgirlpresentedwithamildsorethroat.Thepediatriciannoticedsomeredness,swabbedherthroat,testedforgroupAstreptococci,sentbloodforantistreptolysinOtiter,andprescribedtreatment.Threeweekslater,thegi

2、rlreturnedwithfeverandpainfulswellingofthekneejoints,followedbypainandswellingofelbowjoints.Physicalexaminationshowedapericardialfrictionrubandamurmursuggestiveofmitralregurgitation.TheantistreptolysinOtiterwaselevatedoverthepreviousvalue.Thegirlwashos

3、pitalizedandtreatedwithantibiotics.Sherecoveredanddidwelloverthenextseveraldecades.Inherthirties,thepatientbegantohavedyspneaonexertionandoccasionallyawakenedatnightfeelingshortofbreath.Shehadonefaintingspell,followedbyanepisodeoftemporarylossofvisioni

4、noneeye.Onadmissiontothehospital,shewasveryshortofbreathandhadcoughedupsomeblood-tingedsputum.Physicalexaminationandlaboratorytestssuggestednarrowingofthemitralvalveorifice.X-rayofherchestshowedanenlargedleftatriumandpulmonaryedema.Shewastreatedmedical

5、lyforseveraldaysanddischarged,feelingbetterbutwithsomeresiduallimitationofcardiacfunction.Theweekbeforehernextadmission,shewenttoadentistbecauseoftoothpain,andunderwentadentalextraction.Shereturnedtothehospitalwithhighspikingfeversandovertsignsandsympt

6、omsofheartfailure.Questions:1.Whatisthesignificanceofthehistoryofrheumaticfeverasachild?Whataretheprimarysymptomsofacuterheumaticfever?2.Whatistheetiologyofacuterheumaticfever?3.Whichvalvesaremostlikelytosufferdamage?4.Whyisthispatientfeelingsoshortofb

7、reath?Whyisherleftatriumenlarged?Whyareherlungsabnormal?Whydoesshegetshortofbreathatnight?Doesshehaveheartfailure?Whatkind?Objectives:1.Describetheetiologyofacuterheumaticfever.2.Describethepathologyandnaturalhistoryofacuterheumaticfeverandrheumatichea

8、rtdisease,andknowwhichpartsoftheheartareaffectedinacuterheumaticfever.3.Describethepathologyandnaturalhistoryofchronicrheumaticheartdisease,andknowwhichvalvesaremostofteninvolved.4.DescribeanAschoffbody.Case2History：Therewasasuddendeath