心脏性猝死课件_2.pptVIP

2008.11.11 西安交通大学医学院第二附属医院 心 脏 性 猝 死 Sudden Cardiac Death 西安交通大学医学院第二附属医院 Sudden Cardiac Death ( S C D ) SCD是指心脏原因所引起的、短时间内发生的(急性症状开始1小时内)以意识丧失为前驱的意外性自然死亡。Death occurring within one hour of onset of symptoms due to cardiac causes 不论事前存在的心脏病已被诊断已否，死亡的特征涉及其发生的时间和方式是不可预料的、快速的，并起因于自然的病理生理过程而非人为或外伤因素造成者。 What can you do about it ? Prevention through screening Prompt defibrillation 流行病学EPIDEMIOLOGY 不同地区SCD的发生率因各地冠心病（CHD）的患病率不同而各异，估计美国每年SCD的发生率范围为200 000~450 000p; The geographical incidence of SCD varies as a function of CHD prevalence in different regions. Estimates for the United States range from less than 200,000 to more than 450,000 SCDs annually, Age, Heredity, Gender and Race SCD的发生危险在以下人群中依次增加：正常人群、高危亚组人群（具有导致首次冠脉事件多重危险因素的人群）、有任何冠脉事件史、左室射血分数（EF）≤30%或心力衰竭、心脏骤停复苏者、MI后室性心律失常; ACC/AHA/ESC指南指出，院外心脏骤停、新发心力衰竭、不稳定心绞痛及近期MI后的高危患者，严重心血管事件发生后6~8个月SCD危险最高。 始 动 机 制 SCD的始动机制是心律失常:Ventricular Tachycardia and Ventricular Fibrillation 初始节律：Pulseless Ventricular Tachycardia, Ventricular Fibrillation，Idioventricular Rhythm and Nonsustained Ventricular Tachycardia，Unstable Sustained Ventricular Tachycardia ，Bradycardia and Heart Block MECHANISMS AND SUBSTRATES Mechanisms of Sudden Cardiac Death The rhythm most often recorded at the time of sudden cardiac arrest is VF. Holter recording, 62.4% had VF,16.5% had bradyarrhythmias, 12.7% had torsades de pointes, and 8.3% had primary VT. Substrate for Ventricular Arrhythmias The substrate for SCD varies depending on the underlying structural heart disease. Most studies suggest that three quarters of the patients dying of SCD have CHD. In 5% to 10% of cases, SCD occurs in the absence of CHD or cardiomyopathy. There exists a group of inherited abnormalities such as the long QT syndrome (LQTS), short QT syndrome (SQTS), Brugada syndrome, which can precipitate SCD without Ventricular structural changes in the heart . 病 因 一、冠心病 1、急性心肌梗死 Myocardial Infarction 2、非梗死性心肌缺血 myocardial ischemia 3、心室重构