心脏性猝死ppt课件_2.pptVIP

心 脏 性 猝 死 Sudden Cardiac Death;Sudden Cardiac Death ( S C D );2 8 year old man who died suddenly while wearing a cardiac monitor;What can you do about it ?;流行病学EPIDEMIOLOGY;.;始 动 机 制;MECHANISMS AND SUBSTRATES;常见原因 common causes of cardiac death 1、冠心病coronary disease 2、心肌炎、心肌病 myocarditis、cardiomyopathy 3、心瓣膜病 valvic cardiac disease 4、原发性电生理异常 Electrophysiological abnormal 5、先天性心脏病 Congenital Heart Disease 6、急性心包填塞 acute tamponade cardiac;Epidemiology of VA SCD ;病 因;二、心肌疾病 1、扩张型心肌病 Dilated Cardiomyopathy (DCM) 2、肥厚型心肌病 Hypertrophic Cardiomyopathy (HCM) 3、致心律失常性右心室发育不良 ARVC（Arrhythmogenic Right Ventricular Cardiomyopathy) ARVD (“Arrhythmogenic Right Ventricular Dysplasia”);三、心脏瓣膜病 valvic cardiac disease 四、原发性电生理异常 Electrophysiological abnormal 1、Long QT Syndrome 2、Brugada Syndrome.;Long QT Syndrome in a 16-year-old girl QT=520 ms; Atrial Tachycardia with 2:1 AV conduction;Brugada Syndrome(Typical ST-T abnormality V1-V2);Ventricular Fibrillation;触 发 机 制;危险分层及预测;预 防; 一 级 预 防 primary prevention for patients at risk ;Antiarrhythmic Drugs ? Beta Blockers: Effectively suppress ventricular ectopic beats arrhythmias; reduce incidence of SCD ? Amiodarone: No definite survival benefit; some studies have shown reduction in SCD in patients with LV dysfunction especially when given in conjunction with BB. Has complex drug interactions and many adverse side effects (pulmonary, hepatic, thyroid, cutaneous) ? Sotalol: Suppresses ventricular arrhythmias; is more pro-arrhythmic than amiodarone, no survival benefit clearly shown;Non-antiarrhythmic Drugs ? Electrolytes: magnesium and potassium administration can favorably influence the electrical substrate involved in VA; are especially useful in setting of hypomagnesemia and hypokalemia ? ACE inhibitors, angiotensin receptor blockers and aldosterone blockers can improve the myocardial substrate through reverse remodeling and thus reduce incidence of SCD ? Antithrombotic and antiplatelet agents: m