循环系统内科学心律失常-英文教学课件:arrhythmia-0.ppt
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- 循环系统 内科学 心律失常 英文 教学 课件 arrhythmia_0
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1、ARRHYTHMIAEdited by Yingmin Chen Definition of Arrhythmia: The Origin, Rate, Rhythm, Conduct velocity and sequence of heart activation are abnormally. Anatomy of the conducting systemPathogenesis and Inducement of Arrhythmia Some physical conditionPathological heart diseaseOther system disease Elect
2、rolyte disturbance and acid-base imbalancePhysical and chemical factors or toxicosisMechanism of ArrhythmiaAbnormal heart pulse formation1. Sinus pulse2. Ectopic pulse3. Triggered activityAbnormal heart pulse conduction1. Reentry2. Conduct blockClassification of ArrhythmiaAbnormal heart pulse format
3、ion1. Sinus arrhythmia2. Atrial arrhythmia3. Atrioventricular junctional arrhythmia4. Ventricular arrhythmia Abnormal heart pulse conduction1. Sinus-atrial block2. Intra-atrial block3. Atrio-ventricular block4. Intra-ventricular blockAbnormal heart pulse formation and conductionDiagnosis of Arrhythm
4、ia Medical history Physical examination Laboratory testTherapy Principal Pathogenesis therapy Stop the arrhythmia immediately if the hemodynamic was unstable Individual therapyAnti-arrhythmia Agents Anti-tachycardia agents Anti-bradycardia agentsAnti-tachycardia agentsModified Vaugham Williams class
5、ification1. I class: Natrium channel blocker2. II class: -receptor blocker3. III class: Potassium channel blocker4. IV class: Calcium channel blocker5. Others: Adenosine, DigitalAnti-bradycardia agents1. -adrenic receptor activator2. M-cholinergic receptor blocker3. Non-specific activatorClinical us
6、ageAnti-tachycardia agents: Ia class: Less use in clinic1. Guinidine2. Procainamide3. Disopyramide: Side effect: like M-cholinergic receptor blocker Anti-tachycardia agents: Ib class: Perfect to ventricular tachyarrhythmia1. Lidocaine 2. MexiletineAnti-tachycardia agents: Ic class: Can be used in ve
7、ntricular and/or supra-ventricular tachycardia and extrasystole. 1. Moricizine 2. Propafenone Anti-tachycardia agents:II class: -receptor blocker1. Propranolol: Non-selective2. Metoprolol: Selective 1-receptor blocker, Perfect to hypertension and coronary artery disease patients associated with tach
8、yarrhythmia. Anti-tachycardia agents: III class: Potassium channel blocker, extend-spectrum anti-arrhythmia agent. Amioarone: Perfect to coronary artery disease and heart failure patients Sotalol: Has -blocker effect BretyliumAnti-tachycardia agents:IV class: be used in supraventricular tachycardia1
9、. Verapamil2. DiltiazemOthers: Adenosine: be used in supraventricular tachycardiaAnti-bradycardia agents Isoprenaline Epinephrine Atropine AminophyllineProarrhythmia effect of antiarrhythmia agents Ia, Ic class: Prolong QT interval, will cause VT or VF in coronary artery disease and heart failure pa
10、tients III class: Like Ia, Ic class agents II, IV class: BradycardiaNon-drug therapy Cardioversion: For tachycardia especially hemodynamic unstable patient Radiofrequency catheter ablation (RFCA): For those tachycardia patients (SVT, VT, AF, AFL) Artificial cardiac pacing: For bradycardia, heart fai
11、lure and malignant ventricular arrhythmia patients.Sinus ArrhythmiaSinus tachycardia Sinus rate 100 beats/min (100-180)Causes:1. Some physical condition: exercise, anxiety, exciting, alcohol, coffee2. Some disease: fever, hyperthyroidism, anemia, myocarditis 3. Some drugs: Atropine, Isoprenaline Nee
12、dnt therapySinus BradycardiaSinus rate 3s3. Type II SAB4. Nonsinus tachyarrhythmia ( SVT, AF or Af).5. SNRT 1530ms, SNRTc 525ms6. Instinct heart rate 110ms. Paroxysmal tachycardiaTherapy: AVNRT & orthodromic AVRT1. Increase vagal tone: carotid sinus massage, Valsalva maneuver.if no successful, 2. Dr
13、ug: verapamil, adrenosine, propafenone3. DC shockAntidromic AVRT:1. Should not use verapamil, digitalis, and stimulate the vagal nerve.2. Drug: propafenone, sotalol, amiodarone RFCAPre-excitation syndrome(W-P-W syndrome)There are several type of accessory pathway1. Kent: adjacent atrial and ventricu
14、lar 2. James: adjacent atrial and his bundle3. Mahaim: adjacent lower part of the AVN and ventricularUsually no structure heart disease, occur in any age individualWPW syndrome Manifestation: Palpitation, syncope, dizziness Arrhythmia: 80% tachycardia is AVRT, 15-30% is AFi, 5% is AF, May induce ven
15、tricular fibrillationWPW syndromeTherapy:1. Pharmacologic therapy: orthodrome AVRT or associated AF, AFi, may use Ic and III class agents. 2. Antidromic AVRT cant use digoxin and verapamil.3. DC shock: WPW with SVT, AF or Afi produce agina, syncope and hypotension4. RFCAVentricular arrhythmia Ventri
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