恶性快速性室性心律失常致心源性晕厥的临床观察

目的探讨恶性快速性室性心律失常致心源性晕厥的病因与高危心电图表现。方法分析48例在入院时或入院后至少发生1次心源性晕厥患者的病因及其发作时与发作前后的常规12导联心电图或持续心电监护心电图形。结果48例恶性快速性心律失常致心源性晕厥最常见的基本病因为急性冠心病或陈旧性心肌梗死，其次为扩张型和肥厚型心肌病及其他病因；低钾血症是最常见的诱因；最常见的恶性快速性室性心律失常类型是尖端扭转型室性心动过速。其高危心电图表现：继发性长QT间期综合征；Brugada综合征；异常J波；复杂性室性早搏；急性心肌梗死伴ST—T电交替，或广泛前壁心肌梗死伴墓碑样ST段抬高；扩张型心肌病伴进展性QRS波群低电压。上述各种病因心源性晕厥者有各自不同的临床及心电学特征。结论恶性快速性室性心律失常所致心源性晕厥存在多种病因及高危心电图表现。     

心肌病诊治的近展 心肌病室性心动过速的诊断和治疗

心肌病是室性心动过速的常见病因,但致室速的心肌病类型、室速发病的机理、诊断和治疗上一些特殊问题,本文对此作一简述。一、致心律失常源性心肌病(一)原发性心肌病:原发性心肌进行性损伤,常见形式有扩张型心肌病、肥厚型心肌病和限制型心肌病。各种类型心肌病均有室性心律失常倾向,但扩张型心肌病致室性心律失常更常见,轻则表现室性早搏,重则形成反复性持续性室性心动过速、室颤猝死等。     

动态心电图对老年人心源性晕厥诊断的价值

目的探讨24h动态心电图在心律失常引起的心源性晕厥临床诊断中的应用价值。方法回顾性分析120例疑为心源性晕厥患者的24h动态心电图检测结果。结果120例患者发生晕厥73例，其中69例晕厥发作与严重心律失常发作的时间一致，且与长R—R间期〉3．0S及快速性室性心律失常有关；另4例未记录到晕厥时有心律失常。结论动态心电图检查对怀疑为心源性晕厥的患者具有重要的诊断价值，但对阴性结果者，并不能完全排除心源性晕厥。     

急性心肌梗死并发恶性心律失常的护理

心律失常是急性心肌梗死最常见的并发症之一，因冠状动脉急性闭塞使传导系统的心肌缺血坏死而造成。当心律失常严重影响血流动力学，或由于各种因素致心电不稳定，使某些原来并不影响血流动力学的心律失常进一步恶化称为恶性心律失常。恶性心律失常常见类型：危险性室性早搏、室性心动过速出现休克或左心衰竭、扭转型室性心动过速、严重传导阻滞、病态窦房结综合征等。     

电生理学检查在晕厥诊断中的临床意义

1　发病情况晕厥是常见的临床综合征 ,在美国因晕厥就诊者占急诊人数的 3 % ,占死亡人数的 1 %～ 3 % ,有2 3 %的人一生中发生过一次晕厥 ,对于老年人或充血性心力衰竭及扩张型心肌病患者 ,晕厥可能是独立死亡预测因子 ,因室性心律异常引起的晕厥每年死亡率可达 3 0 %。大部分晕厥患者是自限性的 ,预后较好 ,但部分晕厥病人预后较差 ,其中心源性晕厥的年死亡率最高。由于晕厥的发作时间很短 ,而病人就诊时其发生晕厥的条件已不存在 ,大约 40 %～60 %病人 ,尽管经过详细的病史采集和体格检查以及各种非创伤性检查 ,其病因仍然不能明确 ,由于…     

动态心电图在心源性晕厥诊断中的作用

目的应用动态心电图对心源性晕厥进行诊断与分析。方法对54例疑为心源性晕厥患者行动态心电图检查,嘱其尽量以诱因促使晕厥发作,并记录好时间。结果54例患者中发生晕厥11例,晕厥发作的时间与检出的心律失常一致。主要为心室停搏,表现为长R—R间期,且〉3．5s。结论动态心电图是心源性晕厥常规、有效的诊断方法,可获得直接的病因。     

氨茶碱治疗病态窦房结综合征的疗效观察

<正>病态窦房结综合征(SSS,简称病窦)是临床上较常见的心律失常之一,临床主要表现为脑供血不足和发作性黑朦晕厥。重者出现阿—斯综合征或猝死,心电图出现多种心律失常,但心率以缓慢性传导阻滞为主,个别病人出现快—慢综     

心电图中J波的临床意义

1缺血性J波与室性心律失常 当J波增高增宽形成明显J波或大J波,并见于低温、高血钙、心肌缺血或神经系统病变时,常与恶性心律失常有关.近年来相关研究表明,在急性心肌缺血早期,缺血区心室外膜细胞完全丢失动作电位穹顶,这种非均一性的Ito介导的穹顶完全丢失导致缺血区与非缺血区之间形成显著增大的复极电压梯度,从而易于形成2相折返,其在心电图上的表现为一个在T波上RonT的室性早搏,RonT室性早搏很容易触发室性心动过速/心室颤动,因此引发多种室性心律失常.所以急性心肌梗死超急性期出现J波综合征的患者容易发生室性心律失常.     

动态心电图在心源性晕厥临床诊断中的运用分析

目的对在心源性晕厥患者中用动态心电图检测的临床诊断价值以及具体运用操作进行分析。方法选取本院收治的心源性晕厥高危患者200例相关基线资料为研究数据来源,所有患者用动态心电图检测,以患者是否出现晕厥将其分为A组(有晕厥情况)和B组(无晕厥情况),分别有患者50例、150例。回顾性分析所有患者临床资料后归纳动态心电图对心源性晕厥患者的临床诊断作用。结果在A组患者中有35例患者和缓慢性心律失常存在联系,其中心室停搏时间超过3s患者发生晕厥概率相对偏高,B组患者心室停搏时间均在3s以内。13例患者和快速性心律失常存在联系,余下2例患者无明显心律失常表现。两组患者RR间期对比差异有统计学意义(P<0.05)。结论对临床怀疑为心源性晕厥患者应用动态心电图进行检测,能够保持连续对患者心电信号的掌握了解,保障患者身体和生活质量。     

十二导联动态心电图对不明原因晕厥诊断价值的研究

目的 探讨十二导联动态心电图对不明原因晕厥的检测价值,为临床诊疗提供依据。方法 对127例病因不明的晕厥患者行十二导联动态心电图监测,并嘱咐患者在监测过程中尽可能诱发晕厥,记录晕厥发生时间及心电图变化。结果 127例患者中监测期间发生晕厥者34例,其中发生心律失常的有28例,占82.3%;对晕厥患者心律失常类型的构成比分析发现,窦性心动过缓伴窦性停搏的比例最高（39.3%）,其余依次为房室传导阻滯、室上性心律失常、室性心律;晕厥的发生与心室停搏时间相关,心室停搏时间≥3.0s晕厥发生率增加。结论 十二导联动态心电图对心源性晕厥的诊断有重要意义,能为其确诊提供依据。     

Suspected vasculitis in an adolescent female with cardiomyopathy,myocardial infarction,and heart failure requiring heart transplantation

A 15-year-old girl presented with dilated cardiomyopathy, positive cardiac markers, and electrocardiogram changes suggestive of acute coronary syndrome. Coronary angiography showed giant dilated coronary arteries. Pathological evidence for cardiomyopathy with acute myocardial infarction was present in the explanted heart. Further investigation suggested evidence for a systemic vasculitis: polyangiitis overlap syndrome.     

急性心肌梗死碎裂ORS波与室性心律失常发生的关系

目的研究急性心肌梗死心电图碎裂QRS（fQRS）波与室性心律失常发生的关系。方法回顾性分析200例急性心肌梗死患者,根据其入院5天内心电图有无fQRS波分为fQRS组和非fQRS组,统计分析两组于住院期间室性早搏,室性心动过速和心室颤动的发生率。结果fQRS组室性早搏、室性心动过速的发生率明显高于非fQRS组（P〈O．05）。结论急性心肌梗死后心电图出现fQRS的患者,其室性心律失常的发生率明显高于无fQRS者,fQRS可以作为急性心肌梗死患者室性心律失常发生的预警指标。     

扩张型心肌病49例24小时动态心电图分析

目的观察分析扩张型心肌病（dilated cardiomyopathy,DCM）24小时动态心电图监测（twenty-four-hour ambulatory electrocardionraphic monitoring也称Holter）改变。方法 49例确诊为DCM患者,行Holter监测,分析这些患者24小时动态心电图发生的改变。结果所有患者Holter均有异常改变,以室性心律失常最常见,共47例（95.92%）;房性心律失常次之,共38例（77.55%）;ST-T改变14例（28.67%）,传导阻滞13例（26.53%）等。且心功能越差,复合性心律失常越多见,左房内径（leftatrialdiameter,LAD）越大,复合性房性心律失常越多见,左室舒张末期内径（Left ventricularend diastolicdimen-sion,LVED）越大,复合性室性心律失常越多见。结论 DCM患者24小时动态心电图表现多种多样,心律失常发生率高,且多样、易变。DCM患者早期进行心电图及Holter检测对早期发现心律失常及预后有重要意义。     

Permanent ventricular tachycardia: prognostic and therapeutic problems: three case reports

The permanent ventricular tachycardia (PVT) represent a rare and dangerous arrhythmia that causes prognostic and therapeutic difficulties. Three patients admitted during last year for PVT complicating ischemic cardiomyopathy in two cases and idiopathic cardiomyopathy in the last case. These patients were admitted from emergency department for sustained monomorphic ventricular tachycardia. The ECG showed wide QRS tachycardia of ventricular origin. The direct current shock (DCS) has revealed ECG criteria of old myocardial infarction in two cases. The transthoracic echocardiography displayed dilated left ventricule (LV) with 35% mean ejection fraction. It also showed the presence of LV aneurysm in one case. The cardiac catheterization showed proximal left anterior descending artery obstruction in one patient and left circomflex artery stenosis in other patient. There was no indication of revascularization because of the age of myocardial infarction. The follow-up of these patients demonstrated the persistence of the VT for at least 6 days with recurrence after the DCS and resistant to Lidoca?ne-Amiodarone association. The sinus rhythm was established by the propranolol-Amiodarone in one patient, Amiodarone added to treatment of congestive heart failure for the patient with ventricular aneurysm. The third patient died after one week of PVT complicated by cardiogenic shock just before a trial of radiofrequency ablation (RFA). We concluded through these cases that PVT is a troublesome arrhythmia for more than one reason. It appears of tewly in patients with advanced cardiomyopathy worsening the hemodynamic conditions oftenly the pharmacological treatment is mostly always difficult. The treatment of choice is RFA for those resistant to medical treatment.     

非冠状动脉粥样硬化性心肌梗死16例报告

目的探讨非冠状动脉粥样硬化性心肌梗死的病因及临床特点。方法笔者所在医院近4年收治非冠状动脉粥样硬化性心肌梗死16例,每例行心电图、超声心动图、血清心肌酶和冠状动脉造影检查。结果16例患者冠状动脉造影均未发现斑块和狭窄。结论非冠状动脉硬化性心肌梗死应尽早冠脉造影,病因治疗。     

慢性心力衰竭伴心律失常73例临床分析

目的：探讨慢性心力衰竭（CHF）并发室性心律失常（VA）的发生机制及防治对策。方法：73例并发心律失常的慢性心力衰竭住院患者,均按心衰常规治疗。缺血性心脏病、扩张型心肌病、风湿性心脏病等伴心功能Ⅱ-Ⅲ级者均应用美托洛尔,心功能Ⅳ级或肺源性心脏病用利多卡因、胺碘酮治疗,恶性心律失常则用利多卡因或电击复律。结果：治疗后显效37例,有效31例,总有效率为93％。无效5例（7％）均死于恶性心律失常。结论：CHF发生VA与心肌肥厚相关。恶性心律失常的发生与心功能恶化程度相关。β-受体阻滞剂可作为CHF发生VA的一级预防药物。     

急性心肌梗死Q-T离散度的临床分析

目的:为了解急性心肌梗死Q-T离散度的动态变化,以及与恶性室性心律失常、左房负荷(PTFV1)的关系。方法:测量80例急性心肌梗死病人包括死亡前)住院期间Q-T离散度,比较急性心肌梗死(AMI)入院与出院时Q-T离散度(Q-Td)及校正Q-T离散度(Q-Tcd),比较Q-Td与PTFV1及恶性室性心律失常的相关性。结果:80例AMI住院期间Q-Td动态变化揭示了Q-Td与恶性室性心律失常、PTFV1的密切关系,62例急性心肌梗死Q-Td及Q-Tcd入院时较出院有非常明显延长(P<0.05)。结论:Q-Td可作为预测恶性室性心律失常及心功能不全的一项敏感指标,不失为无创性评估急性心肌梗死预后的手段之一。     

Implantable cardioverter-defibrillator in the treatment of two patients with an increased risk of sudden cardiac death

A 23-year-old female with familial long-QT syndrome and a 48-year-old male with familial dilated cardiomyopathy were given an implantable cardioverter-defibrillator (ICD) as prophylaxis. About half a year after the implantation, there was an appropriate and successful ICD-discharge in both patients in connection with ventricular tachycardia. Treatment with an ICD can be life-saving in patients with cardiac rhythm disorders. The most common indication is ventricular tachycardia or fibrillation due to ischaemic heart disease, but an ICD may also be indicated in patients with cardiomyopathy, congenital heart disease, hereditary arrhythmia or a planned heart transplantation.     

Syncope and sudden death in the adolescent

Syncope is the sudden loss of consciousness and postural tone resulting from an abrupt, transient cerebral malfunction, followed by spontaneous recovery. It is common among adolescents and is usually due to a benign neurocardiogenic (vasovagal) etiology. Rarely, syncope is premonitory of sudden death. The physician must be knowledgeable about the characteristics of neurocardiogenic syncope and what distinguishes it from life-threatening causes. Evaluation of syncope should be based on a complete personal and family history, a thorough physical examination, and an electrocardiogram. Risk factors include syncope that is recurrent, exercise-induced, or not neurocardiogenic in nature; accompanying anginal chest pain, palpitations, and/or dyspnea; cardiac disease; seizure activity; athletic competition; and positive family history for conditions associated with sudden death (e.g., hypertrophic cardiomyopathy, long QT syndrome). Adolescents with these risk factors should be referred to a pediatric cardiologist for specialized testing and management.     

Right bundle branch block and ST-segment elevation in right precordial leads: a marker for sudden cardiac death

The authors present a patient with a specific ECG pattern and a history of syncope and malignant ventricular arrhythmias. Patients without demonstrable structural heart disease and an ECG pattern of RBBB and ST segment elevation in leads V1 through V3 are at risk for sudden cardiac death. They demonstrate the role of cardiac electrophysiology study including programmed ventricular stimulation and pharmacological testing in evaluation of patients with possible Brugada syndrome. The authors emphasize the role of implantable cardioverter defibrillator (ICD) therapy in treatment of patients with Brugada syndrome.