100个医学病例1
CASE 1:
DIZZINESS
眩晕症
History
医学史
（通常包括
主诉：患者的主要不适
现病史：此次发病以来的情况
既往史，个人史，婚育史，月经史，家族史等，
必要时可能涉及职业，住址等基本信息）
A 75-year-old man is brought to hospital with an episode of dizziness*. He still feels unwell when he is seen 30 min after the onset.
episode （可用来表示电视剧等）一集，但在医学中，用在疾病上，通常表示xxx疾病的发作
He was well until the last 6 months, since when he has had some falls, irregularly. On some occasions he lost consciousness and is unsure how long he has been unconscious. On a few occasions he has fallen, grazing his knees, and on others he has felt dizzy and has had to sit down but has not lost consciousness.
These episodes usually happened on exertion（用力）*, but once or twice they have occurred while sitting down. He recovers over 10–15 min after each episode.
He lives alone and most of the episodes have not been witnessed. Once his granddaughter was with him when he blacked out*.
字面翻译是可以的，但优化一下，可以使用医学术语翻译：黑蒙晕厥
Worried, she called an ambulance. He looked so pale and still that she thought that he had died. He was taken to hospital, by which time he had recovered completely and was discharged and told that he had a normal electrocardiogram(ECG) and chest X-ray.
electro 和电有关的；
cardio— 前缀，表示心，如cardiovascular 心血管
所以electrocardiogram 表示心电图
There is no history of chest pain or palpitations*. He has had gout and some urinary frequency. A diagnosis of benign prostatic hypertrophy has been made for which he is on no treatment. He takes ibuprofen occasionally for the gout. He stopped smoking 5 years ago.
palpitation 心悸；gout 痛风；urinary frequency 尿频；diagnosis 诊断；benign 良性，与之相反的是malignant 恶性；prostatic hypertrophy 前列腺增生；ibuprofen布洛芬
He drinks 5–10 units of alcohol weekly. The dizziness and blackouts have not been associated with alcohol. There is no relevant family history. He used to work as an electrician.
one unit of alcohol ，通常在欧洲一些国家如英国使用的酒精剂量单位，以纯酒精度数计算，1单位约等于8g或10ml
Examination
He is pale with a blood pressure of 96/64 mmHg. The pulse rate is 33/min, regular. There are no heart murmurs. The jugular venous pressure （颈静脉压）is raised 3 cm with occasional rises. There is no leg oedema（水肿）; the peripheral pulses are palpable（可触及的） except for the left dorsalis pedis（左足背）. The respiratory system（呼吸系统） is normal.
ANSWER 1
The blackouts do not seem to have had any relationship to posture. They have been a mixture of dizziness and loss of consciousness（意识丧失）.
The one witnessed episode seems to have been associated with loss of colour. This suggests a loss of cardiac output usually associated with an arrhythmia（心律失常）. This may be the case despite the absence of any other cardiac symptoms.
心输出量，既每分钟左心室或右心室射入主动脉或肺动脉的血量。（简单了解为一分钟心脏供应的血液量）
There may be an obvious flushing of the skin as cardiac output and blood flow return.
The normal ECG and chest X-ray when he attended hospital after an episode do not rule out an intermittent conduction（传导） problem. On this occasion the symptoms （症状）have remained in a more minor form.
The ECG shows third-degree or complete heart block.
三度或完全性传导阻滞，异常心电图的一种，提示缺血。
There is complete dissociation of the atrial （心房率）rate and the ventricular（心室率） rate which is 33/min.
The episodes of loss of consciousness are called Stokes–Adams attacks and are caused by self-limited rapid tachyarrhythmias at the onset of heart block or transient asystole.
阿斯综合征：又叫心源性脑缺血综合征，心排出量（见上文解释）锐减导致脑缺血的一系列综合征
tachy—前缀 表示快的，与之相反的是brady—慢的
systole 收缩期，a—前缀时通常表示与单词本身意思相反的，所以asystole表示心脏停搏
Although these have been intermittent in the past he is now in stable complete heart block and, if this continues, the slow ventricular rate will be associated with reduced cardiac output which may cause fatigue（疲劳，比tired程度稍高）, dizziness on exertion or heart failure. Intermittent failure of the escape rhythm may cause syncope.
Syncope 可以表示单词中音节省略，如library可以直接发成莱博瑞，而可以不用发成莱博惹瑞， 医学中指晕厥
On examination, the occasional rises in the jugular venous pressure are intermittent ‘cannon’ a-waves（大炮a波） as the right atrium contracts against a closed tricuspid valve.
大炮a波，又叫巨大a波，或回流波，是由房室分离患者右心房收缩时三尖瓣关闭导致。
In addition, the intensity of the first heart sound will vary.
The treatment should be insertion of a pacemaker. If the rhythm in complete heart block is stable then a permanent pacemaker should be inserted as soon as this can be arranged.
心脏起搏器，分为单腔，双腔，三腔，四腔，可以简单理解为，心脏有左心房，左心室，右心房，右心室，四个腔，哪里需要装哪里
This should be a dual-chamber（双腔） system pacing the atria then the ventricles (DDD, dual sensing and pacing, triggered by atrial sensing, inhibited （抑制）by ventricular sensing) or possibly a ventricular pacing system (VVI, pacing the ventricle, inhibited by ventricular sensing).
If there is doubt about the ventricular escape rhythm （心室逸博心率）then a temporary pacemaker should be inserted immediately.
