本例临床特点如下:1.不规则发热(在38℃左右)4个月;2.从病初开始即有心慌、胸闷,第二次入院时,又发生气急,夜间呼吸困难,咯痰带血,下肢浮肿;3.体检发现心脏增大,心尖有Ⅲ级收缩期杂音及中度滚筒样舒张期杂音,主动脉瓣区有收缩期杂音及泼水样舒张期杂音。肝大有压痛,脉压差大(140/20毫米汞柱),水冲脉;4.血象中白细胞偏高,尿中蛋白(++)及管型(+),血清蛋白电冰示γ球蛋白增高,血培养4次阴性,血沉增快;5.X 线检查肺部有肺炎样变及肺充血,心脏向两侧扩大;6.因顽固性心衰而死亡。一、本例虽无血液动力学监测,但有心慌、气急、咯痰带血、肝大压痛、心脏增大、有杂音等症状体征,诊断为进行性心衰似无异议。本例听诊发现心尖部有向腋部传导之收缩 The clinical features of this case are as follows: 1 irregular fever (at about 38 ℃) 4 months; 2 from the beginning of the illness that is palpitation, chest tightness, the second admission, the occurrence of acute gas, dyspnea at night, Blood, lower extremity edema; 3. physical examination found that the heart increased, apical systolic murmur level Ⅲ and moderate drum diastolic murmur, aortic valve area systolic murmur and watery diastolic murmur. Liver tenderness, pulse pressure difference (140/20 mm Hg), water pulse pulse; 4. Blood leukocyte hyperlocase, urinary protein (+ +) and tubular (+), serum protein electro- Globulin increased blood culture 4 negative, ESR faster; 5.X ray examination of the lungs have pneumonia-like and pulmonary congestion, the heart to both sides of the expansion; 6 due to refractory heart failure and death. First, although this example without hemodynamic monitoring, but there is palpitation, shortness of breath, expectoration and bloody, liver tenderness, heart enlargement, a noise and other symptoms and signs, diagnosis of progressive heart failure seems to be no objection. This case of auscultation found apex to axillary conduction contractions