李丽君心律失常 获得性尖端扭转性室性心动过速课件.pptVIP

Tachyarrhythmias in Emergency Medicine Torsades de pointes (Acquired form ) (TdP) （获得性尖端扭转性室性心动过速） Li Li-Jun (李丽君) Department of Emergency Medicine Second Hospital Key words  Rhythm节律 arrhythmia心律不齐 tachyarrhythmia快速心律失常 antiarrhythmia抗心律失常 action potential 动作电位 depolarization除极 repolarization复极 sodium 钠 potassium 钾 calcium钙 channel 通道 Amiodarone胺碘酮 quinidine奎尼丁 varapamil异搏停 Main points What is a character of electrocardiography of TdP? (尖端扭转室速的心电图特征是什么？） Why do not use some of antiarrhythmic drugs during treatment of TdP?（为什么不用某些抗心律失常药治疗尖端扭转室速？） Torsades de pointes(TdP) ECG - Character of Tosades de Points The ventricular tachycardia（室速） with rates of 200 / min. QRS complexes of changing amplitude（变化的振幅） that appear to twist（扭转） around the isoelectric line（等电位线). A prolonged QT interval（ QT间期） with slow wave（慢波） Longed QT interval with slow wave The time from ventricular(心室)depolarization (除极) to repolarization (复极）. A longed QTc interval: greater than 0.44s. Slow wave. Major Causes of Long QT Interval Antiarrhythmic drugs: I.e class Ⅰ, Ⅲ; Electrolyte abnomalities I.e hypokalaemia（低钾）。 Causes which affects action potential can prolong QT interval. Not use some antiarrhythmic drugs to treat Torsades de pointes Second Main points Why do not use  antiarrhythmic drugs? The longer QT, the easier with TdP. Affect depolarization (除级） or repolarization（复级） by blocking (阻滞） sodium (钠) or potassium (钾) or calcium (钙) channel. Recommendations---ACC/AHA/ESC2006GUIDELINES FOR VA Class 1 (1)withdrawal of any offending drugs and correction of electrolyte abnormalities are recommended in patients presenting with torsades de pointes.(level of evidence:A) (2)Acute and long-term pacing is recommended for patient block and symptomatic bradycardia.(level of evidence:A) ---continual Class IIa: (1)management with intravenous magnesium sulfate is reason