抗心律失常药PPT演示课件.pptVIP

* As we know, the heart beats 2-3 billion times during the lifespan of an average person with normal rhythm, and the cardiac electrical activity can be recorded with electrodes on the body surface. The recorded graph is called ECG. * Different waves and intervals on the ECG reflect the excitation of differential area of the heart and the propagation of excitation impulse within the heart. The ECG is therefore used as a routine tool in diagnosing if a patient’s cardiac electrical activity is normal. The action potential morphology and duration differ from SA node to atrial muscle A-V node, His bundle, Purkinje fibers, and ventricular muscle. These differences are related to the differential distribution of ion channels on the cell membrane. * 抗心律失常药 . * 心电活动和 ECG . 概 述 概念：心跳节律和频率异常 分类： 缓慢型心律失常 窦性心动过缓 （病窦综合征） 传导阻滞 快速型心律失常 房性期前收缩 心房纤颤 心房扑动 阵发性室上性心动过速 室性期前收缩 室性心动过速 心室颤动 * . * . 室上性心动过速 房室传导阻滞 各种心律失常发生部位示意图 * . * 第一节 心脏的电生理学基础 一、正常心脏的电生理特性 二、心律失常的发生机制和药物作用机制 . * Heterogeneous APs in heart . 不应期与动作电位时间 * . * 二、心律失常发生机制和药物作用机制 . 1、冲动形成异常（起源异常） 自律性增高或异常 1) 交感神经功能亢进: 窦房结起搏点冲动发放加速 ?窦性心动过速； 2) 异位起搏点自律性↑?早搏，二联律?反复出现(心动过速); 3) 非自律细胞：心脏工作肌缺血缺氧?静息电位﹤-60mV时，亦能出现自律性异常。 （一）电生理学机制 * . 1) 早后除极 (ealy afterdepolarization ) 特点 C 复极的不一致性（不同步性） A B 是在心肌尚未完全复极时出现的除极，多出现于2相或3相； 主要由Ca2+内流增多所引起； 最大舒张电位水平较高（负值较小)，除极频率快，振幅小。 早后除极与触发活动 * . 750ms 80/min 迟后除极与触发活动 2) 迟后除极 (delayed afterdepolarization) 特点 A B 1000ms 60/min 发生在完全复极之后的4相中（舒张早期）； 是细胞内Ca2+过多诱发短暂Na+内流所引起（钠钙交换）； 最大舒张电位水平较低(负值大)，除极振幅较大。 * . 2、冲动传导障碍 （2）单向阻滞和折返激动（reentry） （1）单纯性传导阻滞 包括传导减慢、传导阻滞及单向传导阻滞 * . A. 正常冲动传导 A B C * . * As we know, the heart beats 2-3 billion times during the lifespan of an average person with normal rhythm, and the cardiac electrical activity can be recorded with electrodes on the body surface. The recorded graph is called ECG. * Different waves and intervals on the ECG reflect the excitation of differential area of the heart and the propagation of excitation impulse w