200例儿童病毒性心肌炎24小时动态心电图结果及应用

作者对２００例临床诊断为病毒性心心肌炎的儿童的动态心电图进行分析，结果表明：２４小时动态心电图，以窦性心律失常为高，其次为房性，传导阻滞，窦性心律失常，动态心电图异常在各年龄组的发生率没有明显差异，９５％以上的病毒性心肌炎患者均可出现各种心电图异常改变。     

高血压病患者P波离散度与房性心律失常的关系

高血压病引起心脏左心室肥厚与房性心律失常的发生率及其发生血栓栓塞以及血流血流动力学紊乱的严重程度密切相关，而高血压病发生左心房重构表现为左房内径增大及(或)存在房性心律失常者并非少数。本文通过分析63例高血压病患者超声心动图和24h动态心电图以及体表同步     

动态心电图对冠心病合并心律失常患者的诊断价值

目的:探讨动态心电图对冠心病合并心律失常患者的诊断价值。方法:选取2019年1月至12月郴州市第一人民医院收治的89例冠心病合并心律失常患者,所有患者均给予常规心电图及动态心电图检查,对比两种检查方法的心律失常检出率及检测方式的综合评价。结果:室性期前收缩二/三联律、房性期前收缩二/三联律、室性期前收缩成对、房性期前收缩成对及短阵室上速等动态心电图检出率均高于常规心电图,差异具有统计学意义(P0.05)。动态心电图检测的安全性及可重复性评分与常规心电图比较,差异无统计学意义(P0.05),准确性评分显著高于常规心电图,差异具有统计学意义(P0.05)。结论:动态心电图对冠心病合并心律失常患者检出率及准确性高。     

动态心电图检测心律失常及心肌缺血临床价值

目的探讨冠心病人动态心电图连续检测24小时心律失常及心肌缺血的变化.方法分析了200例动态心电图,分为冠心病组112例和非冠心病组88例,对两组心律失常及心肌缺血表现进行对比观察.结果房性心动过速冠心病组显著高于非冠心病组(p＜0.05),室性心律失常及心肌缺血发生率冠组高于非冠组p＜0.01,且冠心病患者为无症状性心肌缺血.结论冠心病人应定期行动态心电图检查,对观察心肌缺血程度,预后及治疗效果具有一定临床价值.     

动态心电图在无症状性心肌缺血中的应用

目的:探讨动态心电图在无症状性心肌缺血中的应用价值。方法:选择2018年4月至2020年7月就诊于宜宾市第一人民医院的无症状性心肌缺血患者52例。所有患者行常规心电图与动态心电图检测。观察分析两种检测方式的诊断准确率、心律失常检出率以及发病规律。结果:动态心电图检测心肌缺血的准确率为98.1%,常规心电图为82.7%,差异具有统计学意义(χ²=5.421,P=0.019)。动态心电图检查室性期前收缩、束支传导阻滞、房性期前收缩、心房颤动等心律失常检出率均高于常规心电图(P<0.05)。心肌缺血发作在日间06:00~12:00发生阵次最多。结论:动态心电图在冠心病患者心肌缺血与心律失常监测中的效果优于常规心电图。     

慢性肺源性心脏病并发心律失常78例临床分析

目的 探讨慢性肺源性心脏病并发心律失常的临床特点.方法 对本院2006年1月～2008年12月间121例慢性肺心病患者的临床资料进行回顾性分析.结果 经心电图和心电监护时检查发现121例患者中并发心律失常者78例,占64.46%.心律失常表现为窦性心动过速、窦性心动过缓、房性早搏、室性早搏、心房颤动、心房扑动、阵发性房性心动过速(包括紊乱性房性心动过速)、阵发性室性心动过速、一度或二度房室传导阻滞、右束支传导阻滞(完全性或不完全性)、左束支传导阻滞(完全性或不完全性)、左前分支传导阻滞.Ⅰ°心衰22例,心律失常9例(40.9%);Ⅱ°心衰 41例,心律失常25例(60.97%);Ⅲ°心衰58例,心律失常44例(75.86%).三组之间有非常显著差异(P均＜0.01),提示心衰程度越重,并发心律失常率越高.结论 心律失常是慢性肺心病最常见的并发症之一,肺心病并发心律失常是多种多样的、可变的,了解其心电图特点对慢性肺心病的诊断和治疗具有重要的临床意义.     

动态心电图检测心律失常及心肌缺血临床价值

目的　探讨冠心病人动态心电图连续检测 2 4小时心律失常及心肌缺血的变化 .方法　分析了 2 0 0例动态心电图 ,分为冠心病组 112例和非冠心病组 88例 ,对两组心律失常及心肌缺血表现进行对比观察 .结果　房性心动过速冠心病组显著高于非冠心病组 (p <0 .0 5) ,室性心律失常及心肌缺血发生率冠组高于非冠组p <0 .0 1,且冠心病患者为无症状性心肌缺血 .结论　冠心病人应定期行动态心电图检查 ,对观察心肌缺血程度 ,预后及治疗效果具有一定临床价值     

二尖瓣脱垂综合征与心律失常

人们很早就认识到收缩期喀喇音及收缩期杂音与二尖瓣叶中的一叶或二叶脱垂有关,且已观察到心律失常是其常见表现之一.本文目的在于阐述二尖瓣脱垂(MVP)综合征中心律失常的流行病学、心律失常的种类及心律失常观察方法、预后和猝死的关系、MVP中心律失常的处理.MVP中心律失常的流行病学MVP心律失常的流行病学研究主要基于24h动态心电图,从大量Holter研究资料显示,MVP病人有较高的房性、室性心律失常发生率.房性早博发生率为7.5%～63%,而室性搏早发生率范围较窄为58%～87%,对于室速的发生率还存在争论,房性或室性心律失常在普通人群中也有较高发生率.在Framingham研究中,24h动态心电图     

12导联动态心电图、常规心电图在冠心病无症状性心肌缺血伴发心律失常诊断中的应用效果对比

目的对比分析12导联动态心电图、常规心电图在冠心病无症状性心肌缺血伴发心律失常诊断中的临床应用价值。方法选取2018年5月~2020年5月我院心血管科室收治的120例冠心病患者作为研究对象,全部患者均进行常规心电图以及12导联动态心电图检查,在常规心电图检查完成后实施动态心电图检查,采用12导动态心电记录仪对病人进行24h心电变化连续监测。将所有患者的检查诊断结果记录在册,对比分析两种方法的诊断效果。结果 12导联动态心电图检出心肌缺血阳性率为66.67%,显著高于常规心电图检出率38.33%,差异具有统计学意义(P<0.05);在两种心电图中,房性心律失常(二、三联律及成对期)、房室传导阻滞检出率相比无明显差异(P>0.05);但12导联动态心电图室性心律失常(早发及二、三联律)、房性心律失常(早发期)检出率均显著高于常规心电图,差异具有统计学意义(P<0.05)。结论 12导联动态心电图在冠心病无症状性心肌缺血伴发心律失常的诊断中检出率更高,临床使用价值高。     

慢性肺源性心脏病并发心律失常78例临床分析

目的探讨慢性肺源性心脏病并发心律失常的临床特点。方法对本院2006年1月-2008年12月间121例慢性肺心病患者的临床资料进行回顾性分析。结果经心电图和心电监护时检查发现121例患者中并发心律失常者78例,占64．46％。心律失常表现为窦性心动过速、窦性心动过缓、房性早搏、室性早搏、心房颤动、心房扑动、阵发性房性心动过速（包括紊乱性房性心动过速）、阵发性室性心动过速、一度或二度房室传导阻滞、右束支传导阻滞（完全性或不完全性）、左柬支传导阻滞（完全性或不完全性）、左前分支传导阻滞。I&#176;心衰22例,心律失常9例（40．90石）;II&#176;心衰41例,心律失常25例（60．97％）;III&#176;心衰58例,心律失常44例（75．86％）。三组之间有非常显著差异（P均〈0．01）,提示心衰程度越重,并发心律失常率越高。结论心律失常是慢性肺心病最常见的并发症之一,肺心病并发心律失常是多种多样的、可变的。了解其心电图特点对慢性肺心病的诊断和治疗具有重要的临床意义。     

限钠或补钠对充血性心衰大鼠心钠素及心功能的影响

目的：观察限钠或补钠对充血性心衰大鼠心钠素及心功能的影响。方法：将充血性心衰大鼠随机分为3组（心衰组、心衰限钠组、心衰补钠组J）,假手术大鼠为对照组,用放射免疫分析法测定各组血浆和心肌心钠素水平,同时检测心功能。结果：心衰限钠组血钠、心房心钠素及左室收缩压和动脉压显著低于心衰组,血浆和心室心钠素、右房压均显著高于心衰组;心衰补钠组血钠和动脉压与对照组无显著差别,血浆和心肌心钠素、右房压与心衰组无显著差别,左室收缩压显著高于心衰组,左室舒张末压显著低于心衰组。结论：心衰后适量补钠维持血钠平衡有利于心钠素发挥排钠利尿作用,改善心功能。     

慢性心力衰竭患者左心房功能和不同步性的初步研究

目的运用实时三维超声心动图(RT-3DE)技术定量评价慢性心力衰竭患者左心房容积和功能,并对其不同步性作初步研究。方法选择30例健康受试者和32例慢性心力衰竭患者,分为对照组和心力衰竭组。心力衰竭组:男性18例,女性14例;年龄42~65岁,平均年龄58岁。对照组:男性17例,女性13例;年龄45~60岁,平均年龄54岁。用RT-3DE进行左心房时间-容积曲线分析,获取容积指标:最大容积(LAVmax)、最小容积(LAVmin)、主动收缩前容积(LAVp),计算左心房总射血分数(LATEF)、被动射血分数(LAPEF)及主动射血分数(LAAEF)。同时获得左心房不同步性参数:达最小容积时间标准差Tmsv-16-SD、Tmsv-12-SD、Tmsv-6-SD和最大时间差Tmsv-16-Dif、Tmsv-12-Dif、Tmsv-6-Dif。容积指标用体表面积进行标化,时间参数用R-R间期校正。并分析校正后的不同步性指标Tmsv-16-SD%、Tmsv-16-Dif%与容积指数LAVmaxI等的相关性。结果①各容积指标校正前后,心力衰竭患者左心房容积均增大,左心房射血分数LATEF、LAPEF和LAAEF均减小,差异有显著统计学意义(P<0.01)。②不同步性指标Tmsv-16-SD%、Tmsv-16-Dif%等在心力衰竭组增大,差异均有显著统计学意义(P<0.01)。③Tmsv-16-SD%、Tmsv-16-Dif%与各容积指数呈正相关关系,与各射血分数呈负相关关系,其中与LAVmaxI相关性最强,r分别为0.73、0.75(均为P<0.01)。结论慢性心力衰竭患者左心房功能减低,存在着不同步性。RT-3DE可以较好地评价左心房功能和不同步性。     

慢性心力衰竭合并慢性肾炎患者尿液中B型尿钠肽水平与心功能的相关性研究

目的：探讨慢性心力衰竭(chronic heart failure,CHF)合并慢性肾炎患者尿液中血清B型钠尿肽(B-natriuretic peptide,BNP)水平与心功能的相关性。方法：选取2013年6月至2015年6月在我院接受治疗的慢性心力衰竭患者为观察对象,根据其是否合并慢性肾炎分为CHF组和CHF合并慢性肾炎组。观察两组患者肾功能指标及尿BNP水平,比较两组患者心功能指标的差异,分析肾功能指标、尿BNP与心功能的相关性。结果：CHF合并慢性肾炎组患者尿素氮(blood urea nitrogen, BUN)、血清肌酐(serum creatinine,SCr)和BNP水平明显高于CHF组,而肾小球滤过率(glomerular filtration rate,GFR)水平明显低于CHF组,差异具有统计学意义(P<0.05);CHF合并慢性肾炎组患者左心房直径(left atrial diameter,LAD)、右心房直径(right atrial diameter,RAD)、左室收缩末内径((left ventricular end systolic diameter,LVESD)和左室舒张末内径(left ventricular end diastolic diameter,LVEDD)水平明显高于CHF组患者,左室射血分数(left ventricular ejection fractions, LVEF)水平明显低于CHF组,差异具有统计学意义(P<0.05);CHF合并慢性肾炎患者的BUN、SCr、BNP与LAD、RAD、LVESD和LVEDD正相关,与LVEF负相关,GER水平与LAD、RAD、LVESD和LVEDD负相关,与LVEF正相关。结论：慢性心力衰竭合并慢性肾炎患者尿液BNP水平较高,且与患者的心功能指标密切相关,可作为临床监测指标。     

Studies of auricular catecholamines by fluorescence histochemistry in various heart diseases of man

Summary A comparative histochemical and clinical study concerning the state of the intrinsic adrenergic innervation of the human atrial myocardium was carried out, using the glyoxylic acid-induced fluorescence histochemical method. Specimens from the right auricular appendage were obtained during open-heart surgery from patients suffering from 1. ischaemic heart disease (IHD), 2. atrial septal defect of the secundum type (ASD), and 3. left-sided univalvular or multivalvular heart disease (VHD) with or without congestive heart failure (CHF) experienced prior to surgery. In the IHD group the densities of both the perivascular and the free myocardial adrenergic nerve net were greater than in the ASD group and especially in the VHD/ CHF group. Secondly, the intensity of fluorescence of the adrenergic structures was generally higher in the IHD group than that in the VHD/CHF group. Further, the average size of the varicosities, the number of varicosities per given length of axon, and the proportional share of the large varicosities were greater in the IHD group than in the ASD and VHD/CHF groups. The difference between the IHD and ASD groups was not great but was obvious in any case. In some patients with VHD/CHF fluorescing axons were observed only occasionally, and the tiny varicosities exhibited a hardly discernible fluorescence. Thus the amount of noradrenaline (NA) in the adrenergic fibres in the IHD group seems to be higher than in the ASD and especially VHD/CHF groups. The high level of NA in the IHD group is assumed to constitute a contributory factor in both intracellular metabolic changes and the systemic changes typical of myocardial ischaemia and infarction. In one patient with IHD and in six patients with VHD/CHF with significantly higher heart volume (mean±SD) compared with the rest of the patients (P<0.001), huge local axonal accumulations of NA in the form of droplet fibres were found. These enlarged, bulging adrenergic axons are assumed to be a consequence of mechanical trauma with stretching or disruption of the axons due to myodegenerative processes. It is further assumed that these droplet fibres are relatively common in those patients with diseased myocardium. They may constitute an extra contributory factor to the tendency to arrhythmias so typical of patients of this kind, by increasing the excitability of non-automatic tissue.     

Depression profile in patients with and without chronic heart failure

OBJECTIVE: Depression often goes undetected and untreated in patients with chronic heart failure (CHF). To investigate whether patients with CHF show a specific profile of depression symptoms, we compared depression symptoms in depressed patients with and without CHF. METHODS: Of a total of 921 patients from a CHF and a psychosomatic outpatient clinic, 137 met DSM-IV diagnostic criteria for major depressive disorder and 113 for other depressive disorders. Depressed patients with CHF (n=113) and without CHF (n=137) were compared with respect to severity of individual DSM-IV depressive symptoms, as measured with the PHQ-9. To stratify for depression severity, ANCOVAs with sociodemographic characteristics as covariates were performed separately for patients with major depressive disorder and other depressive disorders. RESULTS: Among the patients meeting the criteria for major depressive disorder, patients with CHF reported significantly lower levels of depressed mood (p=.006) and worthlessness/guilt (p=.019) than patients without CHF. In contrast, no significant group differences were found for any of the other depression symptoms. Group comparisons among the patients with other depressive disorders completely replicated these results (p< or =.001, and p=.04, respectively). LIMITATIONS: Our study population of CHF patients may not be representative for CHF patients recruited in the general population. CONCLUSIONS: The diagnostic features discriminating between depressed patients with and without CHF are the cognitive-emotional symptoms of depression, not the somatic symptoms. This finding may partially explain the low recognition rate of depression in patients with CHF. The different profile of depression symptoms in patients with and without CHF should be considered in diagnosis, treatment and medical education.     

BNP/NT-proBNP: what is the best choice in an emergency laboratory?

BNP and NT-proBNP are both well established as diagnostic and prognostic markers for congestive heart failure (CHF). However it remains for the biologist to choose between these two biomarkers depending on his equipment availability. The aim of this study was to compare results obtained with the Biosite Triage BNP assay and the Dade Behring NT-proBNP assay with regards to the clinical status. One hundred twelve patients (average age 76 +/- 13 years) with acute dyspnea were including and stratified by diagnosis at presentation into 3 groups: patients without acute CHF (group I, n=50), patients with non-cardiac dyspnea and CHF history (group II, n=22) and patients with acute CHF (group III, n=40). Levels of both BNP and NT-proBNP were higher among patients with cardiac dyspnea (group III) than among patients with a non-cardiac dyspnea (BNP=740 pg/mL versus 84 pg/mL; p<0.001 / NT-proBNP=7.502 pg/mL versus 499 pg/mL; p<0.001). ROC analysis for BNP or NT-proBNP were not statistically different in patients with acute CHF (group III) compared with patients with a non-cardiac dyspnea (group I + II) (AUC=0.927 versus AUC=0.930, p=0.90). Neither there was a difference between ROC analysis for BNP or NT-proBNP in patients with cardiac dyspnea (group III) compared to patients with a non cardiac dyspnea (group I) (AUC=0.981 versus AUC=0.975, p=0.76).Measurement of BNP or NT-proBNP is of identical interest for the diagnosis of acute CHF in acute dyspnea. The BNP Biosite assay was faster because analysis is performed on whole blood. With regards to analytical performance, the NT-proBNP Dade Behring assay had a higher accuracy and is highly recommended for the follow-up of CHF treatment.     

Relationship between LRP6 polymorphisms and sudden cardiac death in patients with chronic heart failure in Chinese han population

AIM: Chronic heart failure( CHF),caused by ischemic cardiomyopathy( ICM) and nonischemic cardiomyopathy( NICM),is among the leading causes of mortality and morbidity worldwide. Low-density lipoprotein receptor-related protein 6( LRP6) plays a critical role in regulating Wnt signaling. Dysregulated Wnt signaling contributes to high incidence of arrhythmias. Thus,there might be an association between genetic variations of LRP6 and sudden cardiac death( SCD). The objective of the study was to examine the association between common variants of LRP6 and prognosis of CHF patients. METHODS: From July 2005 to December 2009,patients with CHF referred from 10 hospitals and participants without structural heart disease in China were undergone a prospective study. The single-nucleotide polymorphism rs2302684 was selected to evaluate the effect of LRP6 polymorphisms on the survival of the patients. RESULTS: A total of 1 887 patients(1 437 with CHF and 450 in the control group) were finally enrolled for the analysis. During a median follow-up of 61 months,a total of 546(38. 00%) patients died,including 201(36. 81%) cases with SCD and 345(63. 19%) cases with NSCD. No end point event occurred in the control group. Patients carrying A allele of rs2302684 had increased risks of allcause death( P 0. 01) and SCD( P 0. 01). After adjusted for the other risk factors,the associations remained significant in allcause death( P 0. 01) and SCD( P 0. 01). In patients with CHF caused by ICM,those carrying A allele of rs2302684 also had increased risks of all-cause death( P 0. 01) and SCD( P 0. 01). After adjusted for the other risk factors,the associations remained significant in all-cause death( P 0. 01) and SCD( P 0. 01). However,there was no association between A allele of rs2302684 and prognosis in patients with CHF caused by NICM. CONCLUSION: The SNP rs2302684 T A in LRP6 is associated with an increased risk of all-cause death and SCD in patients with CHF in Chinese Han population,and the association is more prevalent in patients with CHF caused by ICM. Thus,LRP6 might be added as a novel predictor of SCD and could provide an attractive and direct therapeutic target in SCD prevention.     

Exercise-induced ventricular arrhythmias in congestive heart failure and role of ACE inhibitors

Ventricular arrhythmias are considered to be related to left ventricular (LV) dysfunction. ACE inhibitors though improve LV function their beneficial role on exercise-induced ventricular arrhythmias is not established. To study the effects of ACE inhibitors on exercise capacity vis-a-vis their role on exercise-induced ventricular arrhythmias, 25 patients of congestive heart failure (CHF) of various etiologies in NYHA Class II and III were subjected to a prospective randomised controlled trial. The control group comprising of 12 patients received conventional treatment (digitalis and diuretics) and the test group was given enalapril/captopril in addition as tolerated. They were followed up for 3 months. Exercise testing on treadmill and monitoring of clinical and biochemical parameters were done at the beginning and end of study in all cases. Ventricular arrhythmias observed during exercise and post-exercise for 10 minutes was analysed using Lown's grading for frequency and severity of ventricular arrhythmia. The mean exercise duration showed significant improvement on ACE inhibitor as compared to the control group (p < 0.05) however there was no significant change in the grades of arrhythmia. Serum electrolytes and other bio-chemical parameter were within normal range. It is concluded that effect of ACE inhibitor on improving functional capacity in CHF is independent of it's any effect on exercise-induced ventricular arrhythmias.     

心力衰竭患者血浆sTRAIL和sDR5的水平及培哚普利对其影响

目的 :探讨充血性心力衰竭 (CHF)患者血浆可溶型TNF相关的凋亡诱导配体 (sTRAIL)和死亡受体DR5水平的变化及与培哚普利对心脏保护的关系。方法 :用ELISA法检测治疗前后 30例服用培哚普利的CHF患者、2 8例常规治疗的CHF患者及 2 0例健康人对照血浆中sTRAIL及sDR5的水平。结果 :① 5 8例CHF患者血浆sTRAIL的平均含量为 (1.4 3± 0 .4 7)μg/L ,健康人为 (0 .93± 0 .12 ) μg/L ,两者无显著性差异(P >0 .0 5 ) ;sTRAIL水平与心功能损害程度亦无明显关系。CHF患者血浆sDR5的平均含量为 (39.6 7± 6 .78)ng/L ,较健康人 (<6ng/L)明显升高 ,且随着心功能损害程度的加重而升高。②培哚普利组与常规心衰治疗组治疗后 ,血浆中sTRAIL的水平均有所降低 ,但无显著性差异。治疗前后培哚普利组血浆sDR5的平均水平 ,分别为 (31.2 3± 10 .16 )ng/L和 (8.5 0± 2 .14 )ng/L(P <0 .0 5 ) ;常规治疗组分别为 (48.81± 8.74 )ng/L和 (2 6 .6 4± 6 .2 7)ng/L(P <0 .0 5 )。培哚普利组与常规治疗组相比较 ,前者降低更明显 (分别下降 72 .7%和 4 5 .4 % )。③与其他病因所致CHF患者相比较 ,高血压心脏病所致CHF患者血浆sDR5的水平明显升高。结论 :sDR5可能在CHF患者心肌细胞凋亡的发生、发展中起着重要作用。培哚普利可降低C     

Restoring cardiac function: an emerging spectrum of therapeutic options

A spectrum of techniques for restoring cardiac function is emerging. Among patients with global congestive heart failure (CHF), cardiac transplantation may help a small minority for whom allografts are available; the total artificial heart may eventually benefit a larger number. For patients with left-sided CHF, parallel-assist techniques maximally augment cardiac output. In-series techniques can help others without major arrhythmias and some residual cardiac output. As compared with parallel assist, in-series methods offer lesser hemodynamic augmentation but greater intrinsic reliability and the possibility of deactivation of support for hours or days without increased risk. Additional advantages include simplicity of management and documented long-term clinical efficacy.