医、技学院(华盛顿医疗手册培训-心律失常)资料.pptVIP

Cardiac Arrhythmias Jun Jiang Department of Cardiology Mechanisms of Arrhythmogenesis TACHYARRHYTHMIAS Definition Cardiac rhythms whose ventricular rate exceeds 100 beats per minute (bpm). Classification Narrow-Complex Tachyarrhythmia (QRS 120 milliseconds): Wide-Complex Tachyarrhythmia (QRS ≥ 120 milliseconds): History Palpitations (sudden onset or termination) Dyspnea, angina, lightheadedness or syncope and decreased level of consciousness Baseline symptoms that reflect poor LV function dyspnea on exertion Orthopnea paroxysmal nocturnal dyspnea lower extremity swelling History of organic heart disease or endocrinopathy History of familial or congenital causes of arrhythmias hypertrophic cardiomyopathy (HCM) congenital long QT syndrome Medications: Critical to obtain a complete list, including over-the-counter and herbal medications Physical Examination Signs of clinical stability or instability vital signs mental status peripheral perfusion Findings of organic heart disease JVP pulmonary rales peripheral edema Cardiac border S3 gallop murmur Palpate the pulse and assess for rate and regularity. “Cannon” A waves If irregular, then suggestive of underlying AV dissociation and clue for VT If regular in 1:1 ratio with peripheral pulse, then suggestive of AVNRT, AVRT, or a junctional tachycardia Diagnostic Testing Laboratories Serum electrolytes complete blood count (CBC) thyroid function tests a toxicology screen Electrocardiography Imaging Chest radiograph Echocardiogram CT, MRI, CAG Continuous ambulatory ECG monitoring In-hospital telemetry monitoring Event recorders Exercise ECG Electrophysiology study (EPS) Supraventricular Tachyarrhythmias Paroxysmal supraventricular tachycardi (PSVT) Prevalence and incidence of PSVT are 2.25 per 1,000 AVNRT (60%) AVRT (30%) Atrial fibrillation AF is the most common narrow-complex tachycardia seen in the inpatient setting Atrial flutter AFl can often accompany AF and is diagnosed one-tenth as often as AF