第三輪內(nèi)科巡診心律失常

1、韓XX M/80 入院日期：2015-7-13主訴：發(fā)現(xiàn)心律失常1周現(xiàn)病史：1周前晨起自測(cè)脈搏發(fā)現(xiàn)心律不齊，無心悸、胸悶、胸痛、大汗、呼吸困難等不適既往史：糖尿病40年，高血壓病20年，6年前行白內(nèi)障手術(shù)個(gè)人史：吸煙20年，戒煙10年。飲酒30+年?；橛?、家族史無殊入室心電圖入室心電圖入室心電圖Holter緩慢型心律失常與起搏器BradycardiaDefined as a resting heart rate of 60 beats per minute or lessCauses ExtrinsicToxic or environmental exposureElectrolyte imb

2、alance such as hypokalemia or hypocarbiaInfectionSleep apnea HypoglycemiaHypothyroidism or hyperthyroidism Inferior wall myocardial infarction. ( 5% to 10% of acute myocardial infarctions)Increased intracranial pressureMedications that depress sinus nodal function. ( -blockers, nondihydropyridine ca

3、lcium channel blockers, cardiac glycosides (digoxin).)IntrinsicIdiopathic degenerative disease and coronary artery disease, the most common intrinsic causes of sick sinus syndromeInfiltrative diseases such as hemochromatosis , neoplasms, and amyloid Cardiomyopathy Conduction blockHypertensionCongeni

4、tal heart diseaseMusculoskeletal disorders including myotonic dystrophyConditions associated with marked hypervagotoniaincreased vagal toneregular heart beat irregular heart beatsinus bradycardiajunctional escape rhythmfirst degree AVBthird degree AVBventricular escape rhythmsinus arrestsecond degre

5、e type1 SABsecond degree type2 SABsecond degree type1AVBsecond degree type2 AVBhigh degree AVBSinus BradycardiaSinus bradycardia, defined as a sinus rhythm with a resting heart rate of 60 beats per minute or lesshealthy individual,sparticularly young or sleeping patients and in individuals with incr

6、eased vagal tone such as athletessick sinus syndromeClinical ManifestationsSinus bradycardia is usually asyptomaticlightheadedness,syncope,fatigueThe diseased SA node often does not respond appropriately to exerciseAtrioventricular (AV) blockAtrioventricular (AV) block13Atrioventricular (AV) blockFi

7、rst degree AV blockPR0.2s AVNSecond degree AV blockMobitz type 1Mobitz type 2Third degree AV blockAssessmentStable consciouness, vital signs Symptom fatigue, syncopeSourceShort-termSchedule/pacemaker TreatmentPharmacologic therapy atropine 0.52mg iv isoprenaline 14g ivPacemaker implantation is the c

8、ornerstone of treatment for symptomatic patients. 162013 ESC/EHRA Guidelines Persistent bradycardia19Intermittent (documented) bradycardiaSuspected (undocumented) bradycardia212012 ACCF/AHA/HRS Guidelines mendations for Permanent Pacing in Sinus Node Dysfunction mendations for Acquired Atrioventricu

9、lar Block in AdultsChronic Bifascicular Block endations for Permanent Pacing After the Acute Phase of Myocardial InfarctionHypersensitive Carotid Sinus Syndrome and Neurocardiogenic SyncopeSummary of Indicationssymptamatic sinus node diseasethird or second degree type II AVBsecond-degree type I AVB which is found to be located at intra- or infra-His levelssymptamatic third or second degree AVBalternating bund