高血压和心房纤颤课件.ppt

1、心房纤颤心房纤颤 30与高血压相关的心律失常：与高血压相关的心律失常：心房（心房（PAB、AT、AFL、AF）心肌肥厚心肌肥厚,顺应性减低顺应性减低,心房扩大心房扩大心室（心室（PVC、VT、VFL、VF）传导阻滞传导阻滞 机制机制 缺血：无症状缺血缺血：无症状缺血 65%80%左室肥厚：左室肥厚者左室肥厚：左室肥厚者28%合并心律失常合并心律失常 无左室肥厚者无左室肥厚者8%合并心律失常合并心律失常 心力衰竭心力衰竭 高血压病程：长高血压病程：长 血压水平：高血压水平：高 年龄：高龄年龄：高龄 电解质：异常电解质：异常 高血压病史高血压病史 高血压相关的心律失常高血压相关的心律失常病史、体征

2、（心脏肥大），病史、体征（心脏肥大），胸片，超声心动图，冠脉造影胸片，超声心动图，冠脉造影控制血压控制血压缺血缺血:硝酸酯类硝酸酯类,受体阻滞剂受体阻滞剂,钙拮抗剂钙拮抗剂左室肥厚的逆转（左室肥厚的逆转（ACEI、CCB、AIAR）改善心功能改善心功能纠正电解质紊乱纠正电解质紊乱抗心律失常药物抗心律失常药物Alternative TreatmentGallagher MM and Camm AJClin Cardiol 1997;20:381Stambler BS,et al.Circulation 1996;94:1613-1621DisopyramideIa100-150 mg q 6 h

3、rProcainamideIa50 mg/kg/dayQuinidineIaSulfate(200-400 mg q 4-6 hr)gluconate(324-648 mg q 8-12 hr)FlecanideIc50 mg BID(50-200 mg BID)PropafenoneIc150 mg q 8 hr(150-300 mg q 8 hr)SotalolII80 mg BID(120-160 mg BID)AmiodaroneIII800 mg QD x 2 wks,then200-400 mg every dayDrug Type Dose RangeSinus RhythmRe

4、tention Rate(0%)Mean(range)No.StudiesNo drugQuinidineDisopyramidePropafenoneFlecanideSotololAmiodarone31(15-56)41(11-54)49(44-54)39(30-46)62(49-81)42(37-49)53 (36-83)101133334Studies followed patients for at least 6 months after cardioversionCrijns HJGM,Gosselink ATM.Cardio 1994;7:31Fenelon G et al.

5、Pacing Clinical Electrophysiol 1996;19:95Feinberg WM e al.Arch Intern Med 1995;155:469Wolf PA et al.Stroke 1991;22:9831/1 Hylek EM and Singer DE.Arch Intern Med 1994;120:8972 Hylek EM et al.New Engl J Med 1966;335:5403 The Atrial Fibrillation Investigators.Arch Intern Med 1997;157:12371/Absolute Ris

6、kAge 65 years and no risk factors,“lone AF”:1%/yr.All others:3.5%-8+%/yr lowered to 1.5%/yr by warfarinThe Atrial Fibrillation Investigators Arch Intern Med 1994;154:1449 Laupacle A et al.Chest 1995;108Prystowsky EN et al.Circulation 1996;1262Year198919901991199119921994 75 yr1,0074203781,3305257153

7、85INR2.8-4.2 1.5-2.7 2.0-3.0 2.0-4.5 1.4-2.82.0-4.5ASAlimb75 mgNoNo325mgNo325mgEmboli(%/yr)5.5%2.0%3.0%0.4%5.2%3.5%7.4%2.3%4.3%0.9%1.9%1.3%4.8%3.6%riskreduct58%86%37%67%79%32%25%Benefitof ASANoNoN/A-42%N/AN/AAFAAK BAATF CAFA SPAF I SPINAF SPAF II4/4/1.Bjerkelund CJ et al.AJC 1969;23:2082.Klein AL et al.AIM 1997;126:200