老年病态窦房结综合征伴胸痛患者临床分析

老年病态窦房结综合征（SSS）患者,常常伴有胸闷、胸痛等不适症状及吸烟、肥胖等冠心病危险因素,临床上常拟诊为冠心病。为探讨老年病态窦房结综合征与冠状动脉病变的关系,我们在永久心脏起搏器置入术同时进行选择性冠状动脉造影,对有关病因进行探讨。     

病态窦房结综合征临床观察

1978～1979年以来,我院共收治病态窦房结综合征8例,除1例原因不详外,7例均有高血压或冠状动脉硬化性心脏病。应用中西医结合治疗有一定疗效。临床资料 8例患者均为心率<50次/分,伴有窦房阻滞,交界区异位心律或室上性快速性心律失常,房室传导阻滞。患者中女性5例,男性3例,年龄在45～61岁。病人主诉头晕和心     

病态窦房结综合征121例临床分析

病态窦房结综合征(SSS)是临床上常见的疾病,我院从1979年至1989年住院患者中,资料较完整的121例,分析报告如下: 临床资料 121例病窦患者全系住院病人,其中男73例,女48例。年龄20～87岁。诊断标准主要参考1977年北京地区病窦综合征座谈会上所制定的标准。按需要进行了阿托品试验,运动试验,创伤性电生理检查,用心房调搏方法测量窦房结恢复时间(SNRT,校正窦房结恢复时间(CSNRT)、窦房传导时间(SACT),部分病人进行联合阻滞、测定固有心律(IHR)、还对一些病人进行了动态心电图检查。综合分析判断:     

42例病态窦房结综合征临床分析

病态窦房结综合征是内科比较常见的一种疾病,由多种原因引起窦房结起搏和传导功能障碍。常表现严重持久的窦性心动过缓、窦性停搏,窦房阻滞或快—慢综合征。我院内科近年确诊42例,现报告如下。     

病态窦房结综合征50例临床分析

病态窦房结综合征(SSS)临床并非少见。现将我院1978年以来住院确诊且资料较完整的50例分析报道如下。 50例的诊断主要根据1977年北京地区的诊断参考标准。部分病例进行连续24小时动态心电图监测及食管心房调搏试验。 临床资料 1、性别、年龄:男40例,女10例。年龄18～83岁。40岁以上者36例(72％)。     

病态窦房结综合征81例临床分析

病态窦房结综合征患者病因主要为冠心病、特发性传导系统病变及心肌病。病程缓慢,平均为5.78年。病窦波及心房则进展较快,2～5年内发展为双结病变。主张对房室传导功能良好又无严重快速心律失常患者应安置AAI 起搏器。扩张型心肌病预后最差。     

病态窦房结综合征

病态窦房结综合征（sick sinus syndrome,SSS）于1912年Cohn和Lewis首次发现,由Lown于1966年命名。主要是由于窦房结及其邻近组织的器质性病变,引起窦房结起搏功能和窦房结传导障碍,从而产生多种心律失常和临床症状的综合征。过去认为缺血性心脏病、心肌病、风湿性心脏病、心肌炎、高血压性心脏病是最常见的病因,目前认为特发性SSS趋向于主要病因,尤其是在中青年病窦综合征病因中占第一位。根据大量尸解资料表明心脏传导系统     

病态窦房结综合征

病态窦房结综合征(SSS)是指窦房结伴/或不伴有心房病变(有时还累及房室束、心室内传导系统)而产生的心律失常,并由此引起心脏、神经以致全身等一系列表现的临床综合征。自1967年Lown提出这一概念后,近10余年来由于电生理及检测方法的进展,以及临床随访观察的研究,现今对SSS诊断、治疗及其性质的认识均有所提高,故将部分有关资料进行简要综述。     

老年性病态窦房结综合征临床观察

病态窦房结综合征（病窦）是由于窦房结伴有或不伴周围组织解剖上的器质性病变,使起搏功能或传出功能发生障碍或衰竭,产生一系列的心律失常,并引起全身、神经及心脏等表现的综合征。其心律失常的特点为快速心率与缓慢心率交替出现,而以缓慢心率为基础,快速心率表现为房扑、房颤和室速,缓慢心率表现为窦性心动过缓,２：１或３：１的窦房阻滞或窦性静止等,从而在治疗上矛盾重重,且无特殊有效的药物,治疗效果尚不满意。本院治疗２例,现报告如下。１病因治疗 病窦多发生在老年人,中年人以下也不少见,其最常见的基本疾病是退行性变…     

温奇扶元法治疗病态窦房结综合征的临床研究

目的:评价温奇扶元法对病态窦房结综合征(SSS)的疗效及治疗价值。方法:采用随机对照法,将68例SSS患者分为治疗组和对照组,治疗组33例,在常规治疗的基础上给予温奇扶元方;对照组35例,给予常规治疗,4周后比较两者临床表现及心电图变化。结果:(1)临床疗效:治疗组和对照组总有效率分别是90.91%和71.43%,两组差异有显著性(P<0.05);(2)24h动态心电图:治疗组患者治疗后最高心率明显提高(P<0.05),而最低心率、平均心率提高更为明显(P<0.01)。结论:温奇扶元法治疗病态窦房结综合征有明显疗效。     

Pacing for Carotid Sinus Syndrome and Sick Sinus Syndrome

BRIGNOLE, M., ET AL: Pacing for Carotid Sinus Syndrome and Sick Sinus Syndrome. The real incidence of pacemaker implants for carotid sinus syndrome (CSS) and the relation between CSS and sick sinus syndrome (SSS) is not precisely known. Patients who needed pacing therapy because of atrial bradyarrhythmias were investigated by means of carotid sinus massage, dynamic ECG, and invasive electrophysiological sinus node evaluation. Of 298 consecutive patients receiving a pacemaker implant, 36 (12%) had a severe cardioinhibitory carotid sinus reflex with reproducible spontaneous symptoms (CSS), 33 (11%) had sinus bradycardia < 50 beat/min or an abnormal electrophysiological evaluation (SSS) and 24 (8%) had both (CSS + SSS). The annual incidence was 40, 37, and 26, respectively, implants per year/million of inhabitants (total incidence 325). Patients affected by CSS, if compared with those affected by SSS, showed: a higher prevalence of syncope (97% vs 42%); more syncopal, episodes per patient (2.9 ± 2 vs 1.8 ± 0.9); a lower prevalence of associated cardiac diseases (53% vs 100%); cardiac enlargement (36% vs 88%); heart failure (6% vs 36%) and paroxysmal atrial fibrillation (0% vs 42%); and a more frequent indication for VVI pacing (75% vs 3%). In patients with CSS + SSS, intermediate characteristics were present. In conclusion, CSS is as frequent an indication to cardiac pacing as SSS; clinical differences justify a distinction between them, even if they are associated in 26% of cases.     

Atrioventricular Conduction in Sick Sinus Syndrome

With the increasing recognition of the pacemaker syndrome and with the availability of newer methods of pacing therapy, the status of the atrioventricular (AV) conduction in patients with Sick Sinus Sydrome (SSS) becomes crucial in the choice of mode of pacing. At the Philippine Heart Center, from April 1983 to November 1986, the sinus and AV node function studies of 46 patients who, by electrophysiological studies had sinus node dysfunction (SND)-SN recovery time (SNRT) >1400 msec, were reviewed. These were arbitrarily classified according to duration of SNRT into: Group A—borderline SND, SNRT from 1,401 to 1,499 msec (n = 4); Group B—mild SND, SNRT from 1,500 to 2,499 msec fn = 25); Group G—moderate SND, SNRT from 2,500 to 3499 msec fn = 6); Group D— severe SND, SNRT of 3,500 m and above (n = 11). Out of the 46, 14 (30%) had concomittant AVN dysfunction (AVND)—antegrade block rate < 130 beats per minute (BPM). The percentage occurrence of AVND was noted as follows: Group A—25% (1/4); Group B—28% (7/25); Group G—50% (3/6); Group D—27% (3/11). Out of the 14 patients with concomittant AVND, 5(35%) had antegrade block rate < 100 BPM, 3 in Group R and 2 in Group D. The study shows that AVND occurs in only 30% of SSS patients. Its occurrence and severity has no bearing on the degree of SND. In these, antegrade block was at a rate higher than 100 BPM in the majority of patients. The data suggest that most of SSS patients may benefit from atrial demand pacemaker which therapeutically is of more advantage over the ventricular demand type inasmuch as AV synchrony is retained, thus pacemaker syndrome is prevented.     

Antibodies to Human Sinus Node in Sick Sinus Syndrome

The incidence of autoantibodies against human conducting tissue was studied in 45 pacemaker patients with sick sinus syndrome (SSS), in 17 patients with bradyarrhythmia, and jive patients with hypertensitive carotid sinus syndrome. Antibodies against the human sinus node were demonstrated in 29% of patients with SSS and in 24% of patients with bradyarrhythmia; a tenfold risk of SSS could be calculated in patients with this antibody as compared to age-matched controls. At least two subtypes of anti-sinus node antibodies were demonstrated: an antibody absorbable and another one not absorbable with ventricular myocardium. Patients with SSS and prior myocarditis of rheumatic fever have a threefold incidence of that antibody, demonstrating that anti-conducting tissue antibodies are etiologic indicators for former inflammatory heart disease. These antibodies may play a role in the secondary immunopathogenesis of sick sinus syndrome. This hypothesis emerges as an interesting new pathogenetic concept.     

Obscure Syncope and the Sick Sinus Syndrome

This report describes a 25-year-old vigorous young man who had a history of eight years of near syncope and syncope of unknown etiology. Repeat in-hospital observation and laboratory electrophysiologic functional testing did not elucidate the origin of the symptoms. Prolonged Holter monitoring finally showed that the syncopal attacks were caused by a sick sinus syndrome (SSS). On electrophysiologic study, a concealed rate-dependent unidirectional antegrade accessory A-V pathway (AP) was found to be present. The AP was an incidental finding and was unrelated to the patient's symptoms. The symptomatic SSS may occur in the young as well as in the elderly. Sinoatrial dysfunction may be intermittent and difficult to detect, may cause severe symptoms, and may even be life-threatening. Prior to definitive therapy (such as the permanent implantation of a pacemaker), the importance of relating symptoms to a rhythm disturbance has been stressed. In cases where the cause of the symptoms is not obvious, this is best accomplished by continuous Holter monitoring.     

The Natural History of Sick Sinus Syndrome

A literature review has addressed the two major factors in disease progression in sick sinus syndrome: atrioventricular block and atrial fibrillation. An incidence of atrioventricular block of 8.4 percent in a follow-up period of 34.2 months is considered clinically significant and sufficient to justify use of a ventricular lead in pacemaker management. Atrial fibrillation occurs much more commonly [22.3%] in ventricular pacing than with atrial demand pacing (3.9%) in a 21/2 year observation period. Coincident with the reduction in arrhythmia achieved by atrial demand pacing is a significant reduction in systemic embolism (1.6% vs. 13%]. This is considered largely to be due to the improved rhythm control with AAI pacing but also possibly to the avoidance of retrograde atrioventricular conduction. The benefits of AAI pacing in terms of mortality in sick sinus syndrome have not yet been fully assessed. In the future, DDI pacing is recommended with, in some patients, the addition of another sensor to provide rate responsiveness on exercise.     

温阳益气法治疗病态窦房结综合征

<正>病态窦房结综合征是窦房结的起搏和冲动传出发生障碍而引起一系列临床表现和心电图变化的总称,以心动过缓为主,也可发生异位性心动过速,目前尚无有效的治疗方法。     

冠状动脉造影术后卧床时间的临床研究

目的为减少冠状动脉造影术后患者因卧床和患肢制动时间长而引起的各种不适,探索冠状动脉造影术后卧床和患肢制动的最佳时间。方法将121例行冠状动脉造影的住院患者随机分为缩短卧床时间组(实验组)和常规卧床时间组(对照组),分别按2种时间、方式进行术后指导、护理观察。结果经统计学处理显示2组有明显差异,实验组术后各种并发症明显少于对照组。结论减少了患者的痛苦,为今后冠状动脉造影术后患者卧床时间和患肢制动方式提供了可靠的临床依据。