心律失常冯书文__培训课件.ppt

心律失常的治疗 TREATMENT 药物治疗 Pharmacotherapy 介入治疗 Intervention 手术治疗 Surgery 抗心律失常药物的合理应用 Antiarrhythmic 正确合理适用的原则 Principles of medicine 抗心律失常药物的分类Classification of drugs 介入治疗和手术治疗Interventional Surgical 射频消融治疗快速性心律失常的适应证 心脏起搏治疗的适应证 介入治疗和手术治疗Interventional Surgical 心室颤动Ventricular Fibrillation;Vf 电静止 Asystole/Ventricular Standstill 猝死发作心电图 6:02 AM 6:05 AM 6:07 AM 6:11 AM 猝死的心律失常基础underlying arrhythmia of SCD 室速 62% 心动过缓 17% 尖端扭转 13% 原发室速 8% 心室起搏-VVI模式 双腔起搏-DDD模式 * * A, Sinus tachycardia (150 beats/min) in a patient during acute myocardial ischemia; note the ST segment depression. P waves are indicated by arrows. B, Sinus bradycardia at a rate of 40 to 48 beats/min. The second and third QRS complexes (arrows) represent junctional escape beats. Note the P waves at the onset of the QRS complex. C, Nonrespiratory sinus arrhythmia occurring as a consequence of digitalis toxicity. Monitor leads. * This may occur in individuals with healthy hearts. It may also occur with increased vagal tone, myocarditis, MI, and digitalis toxicity. If the pause is prolonged, escape beats may occur. The treatment of this dysrhythmia depends on the underlying cause. If the cause is due to increased vagal tone and the patient is symptomatic, atropine may be indicated. * Rate atrial 250-350/min; ventricular conduction depends on the capability of the AV junction (usually rate of 150-175 bpm). P wave not present; usually a saw tooth pattern is present. QRS normal Conduction 2:1 atrial to ventricular most common. Rhythm usually regular, but can be irregular if the AV block varies. * Rate atrial rate usually between 400-650/bpm. P wave not present; wavy baseline is seen instead. QRS normal Conduction variable AV conduction; if untreated the ventricular response is usually rapid. Rhythm irregularly irregular. (This is the hallmark of this dysrhythmia). * Rate variable P wave usually obscured by the QRS, PST or T wave of the PVC QRS wide 0.12 seconds; morphology is bizarr