心肌橋合併心律不整的中醫診療病例報告

一位53歲男性，在106年2月20日連續二日發作劇烈左胸痛連左手臂，合併呼吸困難、冒冷汗將近暈厥，先後被送台南某醫學中心急診，診為不穩定性心絞痛（unstable angina）收住院。24小時心電圖發現心室早期收縮（ventricular premature contraction）與陣發性心房頻脈（paroxysmal atrial tachycardia）。電腦斷層冠狀動脈血管攝影顯示冠狀動脈左前降支主幹有心肌橋（myocardial bridge）。病人經治療後於106年2月25日病情穩定出院。但卻留下每日晨起陣發心搏過速超過130次／分，易胸悶心悸與受驚嚇反復不癒，因影響正常工作，遂於106年8月31日至本院中醫部求診。來診時依中醫辨證原則：每日晨起心搏過速，胸悶心悸吸不到氣，伴易驚嚇。平時怕冷、易疲倦、易出汗、舌質淡紅，是心氣虧虛，心陽不振。體型肥胖、高血脂症、睡眠呼吸中止、脈沉滑、舌體胖，是痰飲內停。處方以桂枝湯為君以溫通心陽，生脈散為臣以顧護心氣心陰，配合二陳湯健脾化痰濁，與其他寧心安神藥物。服藥三週內，晨起陣發心搏過速逐漸減緩，而至消失，三個月後即未再發生胸悶心悸。遂停藥，至今已逾四年，近日電話隨訪，自述近四年來均未再發作心搏過速、胸悶與心悸。在住院期間，西醫有效的控制了這個心肌橋病人的不穩定性心絞痛與陣發性心房頻脈。出院之後，中醫藥成功的解決了病人反復不癒的心搏過速與胸悶心悸的問題，讓病人恢復正常生活作息。

關鍵字

心肌橋；不穩定性心絞痛；心搏過速；心氣虛；桂枝湯；生脈散

並列摘要

A 53 years old man, who had suffered from recurred tachycardia and palpitation came to our ward for help. According to his statement, this illness had happened about half one year ago, episodic left chest pain combined with dyspnea, cold sweating and syncope happened, he was sent to the Emergency ward of another medical center and admitted under the diagnosis of unstable angina. 24hours Holter's EKG showed Ventricular premature contraction and Paroxysmal atrial tachycardia. ECG-gating coronary artery CTA Tomography revealed complete Myocardial Bridge 1.2 cm at the anterior descending branch of the left coronary artery. The illness was subsided after treatment, so he was discharged. But the persistent tachycardia>130 beats/min every morning、chest tightness、palpitation and easily scared kept him away from his routine work, so he came to our ward for help. As the principle of Chinese Syndrome Differentiation: Repeated tachycardia, chest tightness, palpitation, easily scared, afraid of cold, easily fatigue, easily sweating, pale and red tongue indicated the Qi and Yang Deficiency of the Heart. Obesity, hyperlipidemia, obstructive sleep apnea syndrome, deep and slippery pulse and the enlarged tongue revealed the Phlegm retention. So, Gui-zhi decoction、Sheng-Mai San and Er-Chen decoction were prescribed in combination with herbs of nourishing the Qi and Blood of the Heart. The Recurrent tachycardia was controlled progressively within 3 weeks. The chest tightness and palpitation gradually disappeared in the following 3 months. As the illness was under stable controlled, the Chinese medicine was discontinued in the following four years. As the recent telephone follow up, the patient said the paroxysmal tachycardia, chest tightness and palpitation had never recurred up to now. Western Medicine controlled unstable angina and paroxysmal atrial tachycardia of the myocardial bridge patient during the hospitalized period. After discharged, Chinese medicine solved the repetitive tachycardia, chest tightness and palpitation of the patient, and recover him to his normal lifestyle.

並列關鍵字

Myocardial bridge ； Unstable Angina ； Tachycardia ； Qi Deficiency of the Heart. ； Gui-zhi decoction ； Sheng-Mai San

參考文獻

Donald S., Baim,MD.,: Grossman`s Cardiac Catheterization, Angiography and Intervention. Seventh Edition. LIPPINCOTT. Williams & Wilkins A Wolter Kluwer Company. Philedelphia 2006, p.219.

Google Scholar

Joseph G., Murphy, Margaret A., Lioyd：Myocardial Bridge, Mayo Clinic Cardiology, Third Edition. Mayo Clinic Scientific PRESS, USA, INC, 2007: p.46.

Google Scholar

Richard LV., Murray AM., Meir HK, Thomas R., William CD, Sleep related Cardiac risk. :Principles and Practice of Sleep Medicine. 4th ed. Philadelphia: Isevier Saunders, 2005, pp.1161-1170.

Google Scholar

R.W.Alexander, R.C.Schlant, V. Fuster: Myocardial bridge, HURST^s The Heart, Arteries and veins. The McGraw-Hill Companies, Inc., Health Professions Division, New York, 1998:pp.1203-1208.

Google Scholar

American Thoracic Society. Indications and standards for use of nasal continuous positive airway pressure(CPAP) in sleep apnea syndromes. Am J Respir Crit Care Med, 1994:150: 1738-1745.

Google Scholar

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