岚哥岚嫂说病例第2季第01期(病例部分)

A 66-year-old retired carpenter presents with chronic shortness of breath upon exertion. He has smoked a pack of cigarettes per day for the past 5 years and drinks alcohol regularly. On physical examination, a displaced point of maximal impulse and hepatosplenomegaly are noted. His medications include pantoprazole for gastroesophageal reflux and sertraline for depression. Echocardiogram reveals an ejection fraction of 30% and dilated left and right ventricles. Laboratory test results are:

Na+ 129 mmol/L

K+ 5.2 mmol/L

Cl- 101 mmol/L

Blood urea nitrogen 45 mg/dL

Creatinine 1.3 mg/dL

Glucose 134 mg/dL

Aspartate aminotransferase 220 U/L

Alanine aminotransferase 140 U/L

Alkaline phosphatase 280 U/L

Question:

1.What is the most likely diagnosis?

2.How to differential diagnosis with dilated cardiomyopathy?

3.What is the most appropiate treatment?

译文:
本次病例的患者为一名66岁的退休木匠,患者的主要表现为慢性劳力性呼吸困难。在过去5年里,该患者有每天一包烟的吸烟史,以及规律的饮酒史。患者在体检中发现心尖搏动点移位,以及肝脾肿大。用药史方面,患者服用治疗胃食道反流的泮托拉唑和治疗抑郁症的舍曲林。入院检查,心超显示射血分数为30%,双心室扩张。实验室检查结果如下:Na+ 129 mmol/L,K+ 5.2 mmol/L,Cl- 101 mmol/L,尿素氮(BUN)45 mg/dL,肌酐 1.3 mg/dL,血糖 134 mg/dL,AST 谷草220 U/L,ALT 谷丙140 U/L,碱性磷酸酶 280 U/L。

问题

1、根据上述病情,患者最可能的诊断是什么?

2、该疾病与扩张型心肌病如何鉴别?

3、该疾病最适合治疗方案是什么?

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