糖尿病合并冠心病研究进展

糖尿病（DM）是一个世界性流行病，已成为各国的公共健康问题。据估计，到2030年其患病率将由2000年的2．8％上升至4．4％。且到2030年时，中国、印度与美国将成为DM患者最多的3个国家。     

吞咽诱发房性心动过速一例

吞咽引起的心律失常很少见。我们收治1例,用心律平治疗有效。现报告如下。患者,男,52岁。一月来进食(特别干硬食物)或饮水时有短阵发作性心悸,吞咽完毕,症状消失。心电图证实有吞咽诱发的短阵性房速。曾给服异搏定,治疗无效而于1988年1月11日入院。有高血压病史20余年,无心前区疼痛和胃肠疾病史。     

Clinical and familial study of arrhythmogenic right ventricular cardiomyopathy

Objective　To explore the characteristics of arrhythmogenic right ventricular cardiomyopathy (ARVC). Methods　Seven patients with arrhythmogenic right ventricular cardiomyopathy and 34 members of three families were studied. All patients and family members underwent history collection, clinical examination, electrocardiogram (ECG), two-dimensional echocardiography (2-DE) and a signal averaging electrocardiogram. Programmed ventricular stimulation was performed in five patients. Results　All patients and family members had normal morphologic characteristics and normal function of the left ventricular by 2-DE. Fourteen persons had abnormal findings indicating ARVC. Five had enlargement of the right ventricular with diffused hypocontractility, eight had thin and systolic bulging in the focal anterior wall with hypokinesia and one had bulging of the inferior wall. Twenty-five persons (seven patients and 18 family members) had abnormal findings in ECG. Positive ventricular late potential was recorded in 13 persons (six patients). Two to three monomorphic ventricular tachycardia (VT) with left bundle branch block (LBBB) configurations were induced in five patients. Ventricular fibrillation was induced in two patients during the electrophysiologic study (EPS). Five patients had very high pacing threshold and/or ineffective pacing in one or many regions of the right ventricle. Two members of one family died suddenly. One member was a dwarf with ARVC. Spontaneous VT with a left bundle branch block (LBBB) configuration was recorded in five patients, polymorphic VT with extremely short coupling interval in one, and premature ventricular complexes with LBBB configuration in 12 (six patients). Conclusion　Our familial study strongly suggests that ARVC may be a hereditary disease and it is helpful in the diagnosis and detection of ARVC. The most common manifestations were abnormal structure and function of the right ventricle and abnormal ECG of repolarization and ventricular arrhythmia which originates from the right ventricle.     

Efficacy and Mechanism of Intravenous Sotalol for Termination of Paroxysmal Supraventricular Tachycardia

ＳＶＴ ,ｉｎｃｌｕｄｉｎｇＡＶＲＴａｎｄＡＶＮＲＴ ,ｉｓａｋｉｎｄｏｆａｒｒｈｙｔｈｍｉａｏｆｔｅｎｓｅｅｎｉｎｃｌｉｎｉｃａｌｐｒａｃ ｔｉｃｅ .Ｓｏｔａｌｏｌ,ａｃｌａｓｓⅢａｎｔｉ ａｒｒｈｙｔｈｍｉｃｄｒｕｇｗｉｔｈａｄｄｉｔｉｏｎａｌβ ｂｌｏｃｋｉｎｇａｇｅｎｔｐｒｏｐｅｒｔｉｅｓ ,ｈａｓｂｅｅｎｗｉｄｅｌｙｕｓｅｄｔｏｔｒｅａｔｖａｒｉｏｕｓａｒｒｈｙｔｈｍｉａ(ｓｕｐｒａ ｖｅｎｔｒｉｃｕｌａｒａｎｄｖｅｎｔｒｉｃｕｌａｒ)ｅｆｆｉｃｉｅｎｔｌｙｉｎｗｅｓｔｅｒｎｃｏｕｎｔｒｉｅｓ[1 9]…     

“快－慢”型室上性心律失常的射频导管消融治疗及随访

目的：探讨射频导管消融在治疗“快—慢”型室上性心律失常中的作用。方法：用射频导管消融的方法治疗了４例“快—慢”型室上性心律失常病人。结果：１９９１年１月至１９９６年１月间，对２４１例次各种快速性心律失常进行了射频导管消融治疗。其中４例为“快—慢”型室上性心律失常，２例为反复发作性房室结折返性心动过速（ＡＶＮＲＴ），终止时有长时间的心脏停搏并引起晕厥，原准备安装永久性心脏起搏器，ＡＶＮＲＴ根治后，由其引起的症状不复存在，电生理检查窦房结功能正常，故未安装起搏器；另２例均已植入永久性心脏起搏器，１例频繁发作快速心室率心房颤动并经常引起急性心功能不全，１例反复发作ＡＶＮＲＴ、心房扑动和心房颤动且有明显的症状，射频导管消融治疗后症状均消失，射频导管消融术对起搏器的功能无影响。３例平均随访３１±２个月，１例随访２个月未见并发症和临床症状复发。结论：射频导管消融法治疗“快—慢”型室上性心律失常具有重要的临床价值。     

地高辛治疗心力衰竭的现代概念

l地高辛独特的抗心力衰竭机制,地高辛通过多种机制发挥对心力衰竭（心衰）的治疗作用：（1）抑制心肌细胞膜Na＋_K’ATP酶泵,使细胞内钙离子浓度增加,加强心肌收缩力,从而反射性降低末梢阻力．改善心排血量：并发挥利尿作用与减慢心率（介导交感神经作用）,最终降低左心室舒张末期压与心肌氧耗量。     

Kearns-Sayre综合征的心血管并发症(1例报告)

Kearns-Sayre综合征(KSS)是一种少见的线粒体肌病,由下列三联征组成:慢性进行性眼外肌麻痹、视网膜色素变性、心脏传导系统缺陷.真实发病率目前尚不清楚.KSS可以表现为肌无力,中枢神经系统的功能障碍,内分泌病和心脏畸变.肌无力表现为眼球运动的慢性进行性降低,双眼睑下垂和言语困难.中枢神经系统功能障碍包括耳聋,共济失调和痴呆.     

三磷酸腺苷静注诊断10例隐性预激综合征

选择窦性心律时心电图无心室预激波(PEC)的44例阵发性室上速和6例仅有短PR间期者施行三磷酸腺苷(ATP)分级递增快速静注(ATP_Ⅳ)和诊断性电生理研究(DEPS)。结果:ATP_Ⅳ和DEPS分别揭示出隐性预激综合征(PE_L)10/50例和9/50例;ATP_Ⅳ揭示的10例PE_L中有6例在显示PEC前或中出现非预激搏动的房室结传导延缓或阻滞;ATP_Ⅳ未生严重并发症。提示(1)ATP_Ⅳ是诊断PE_L的一种简便、敏感和较安全的方法;(2)ATP_Ⅳ时PEC的揭示主要与ATP对房室结前向传导的负性变导性作用有关。