室上性心动过速学习.pptxVIP

会计学1室上性心动过速 IntroductionPathophysiologyDiagnosisTreatmentAcuteChronicExcluding Atrial Fibrillation and Flutter第1页/共37页 EpidemiologyCommon problem presenting ED’sOrejarena, J AM Coll Card. 1998;31:150-7Mean age of onset 57 yearsRanging from infancy to 90 years oldIn this study, younger patients (mean of 37) were more likely to present to the ED and less likely to have structural heart disease(69%)第2页/共37页 MechanismsTwo basic mechanisms leading to all TachyarrhythmiasImpaired impulse initiationproblems of abnormal automaticityAbnormal impulse conductionRe-entrant impulses第3页/共37页 Location of disorderSVT is any arrhythmia arising from AV node or aboveImpulses can be transmitted from several loci Sinus NodeAtriumAV NodePoint of origin has implications for treatment第4页/共37页 AV NodeThere are two basic forms of SVT’s arising from the AV nodeAtrioventricular Node Reciprocating Tachycardia(AVNRT)Atrioventricular Reciprocating Tachycardia(AVRT)Both are dependent on the AV node for maintenance of the Reentry circuit第5页/共37页 Reentry CircuitsMines in 1913 first described reentry as a mechanism of cardiac arrhythmiasNeed a ring of conduction with unidirectional block in one branch第6页/共37页 AVNRTAccounts for more than half of the cases of PSVT’sFast and slow conducting fibers from the atrium to the AV node make up reentry circuitFast fibers have a long refractory periodSlow fibers have a shorter refractory period第7页/共37页 AVNRT(cont)Cycle is started by a PACFast fibers are still refractory from previous impulseImpulse conducted down Slow fibers and retrogradely up fast fibersThis slow-fast mechanism accounts for 90% of AVNRT’s第8页/共37页 AVNRT(cont.)From Schilling, Heart 2002;87:299–304第9页/共37页 AVRTDependent on an accessory pathwayWolf-Parkinson-White syndromeCan have either Orthodromic or Antidromic conduction through the AV nodeMost common is Orthodromic with retrograde conduction through the accessory pathway第10页/共37页 AVRT(cont.)From Schilling, Heart 2002;87:299–304第11页/共37页 AVRT(co