北京积水潭医院精品课件-心律失常.ppt

病例 患者：男31岁，4天前开始发热38~39.3度，近2天出现胸闷，活动后气喘，心慌，不能平卧到医院就诊，血压：85/45mmhg，心电监测显示：间断出现下列心电图改变： 问题：心电图诊断？ 如何处理？ Any of the atrial arrhythmias listed in the slide may indicate the need for pacing therapy. Sinus node dysfunction (sick sinus syndrome) is dysfunction of the SA node that affects impulse formation and/or conduction. It includes a variety of problems including sinus bradycardia, sinus arrest, sinus pause (SA exit block), brady-tachy syndrome, and chronotropic incompetence. Each of the atrial arrhythmias listed in the slide are described in more detail in the next several slides. When presenting these slides: Note in particular the symptoms for each condition. Referring physicians should be made aware of these symptoms, since they may indicate the need for pacing therapy. Note that these symptoms are often transient and may not be apparent upon examination. Include clinical experience, anecdotes, and cases to better teach about the various arrhythmias--make it more relevant and interesting to participants. Sinus bradycardia occurs when the SA node fires at a slow ( 60 bpm) rate. Sinus arrest occurs when there is a pause in the rate at which the SA node fires. With sinus arrest there is no relationship between the pause and the basic cycle length. Brady-tachy syndrome occurs when the SA node has alternating periods of firing too slowly ( 60 bpm) and too fast ( 100 bpm). Brady-tachy syndrome often manifests itself in periods of atrial tachycardia, flutter, or fibrillation. Cessation of the tacycardia is often followed by long pauses from the SA node. Most of the pacing population relies heavily on rate reserves to increase cardiac output because stroke volume reserves are diminished. Heart rate variability is especially important for nearly all elderly patients since they rely on heart rate reserves even during normal daily activities. It is important to be able to able to increase heart rate with activity (chronotropic competen