孟庆义 危重症的心律失常.ppt

危重症心律失常;;;;;;;;8、颈髓损伤;9、AMI再灌注性心律失常;;10、颈动脉窦按摩;11、R-on-T phenomenon;;;;;常见现象 ;1、心脏停搏;;2、心室颤动 ;;;3、扭转性室速(TDP);;;;1.Tosades de pointes.The long QT interval with the U wave distorting it,the pause before the onset of the tachycardia,and the typical undulating,spindle appearance of the pattern are evident.;2 Warning signs and development of TaP in a patient receiving oral procainamide 500mg four times a day.A,The prolonged QT interval and the PVC are occurring on the T wave.B and C,The typical pattern of TaP has developed.;5 TdP caused by the bradycardia of complete heart block.(Am Heart J 1972,83:535);5 TdP caused by the bradycardia of complete heart block.(Am Heart J 1972,83:535);6 The onset of TdP.A,A prolonged QT-U and a PVC.B,There is a short run of VT,which develops into TdP,C.;7 Polymorphic ventricular tachycardia with a normal QT interval in a patient with CHD.A.Spontaneous episode of polymorphic VT.B,Sustained episode leading to ventricular fibrillation.C,Patient had CHD but continued to have such episodes after myocardial revascularization and beta blockade.(Cir 1990,82:1561);8 Polymorphic VT with a normal QT interval in a patient with AMI.A,Nonsustained polymorphic VT.B,Another episode that leads to rapid degeneration into VF.(Cir 1990,82:1561);9 Recording of 3 episodes of polymorphous VT in a patient on day 5 after AMI.The first two episodes were preceded by ST-segment elevation on the ECG.The normal QT interval and the absence of bradycardia or a sinus pause immediately before the initiation of polymorphous VT are evident.(Cir 1991,84:1543);10 Recording from recurrent episodes of polymorphous VT in a patient who had received intravenous tPA for treatment of AMI.All three tracings show ST-segment elevation before the onset of the tachycardia.A and C,A Pause immediately precedes the onset of the tachycardia.B,An episode of VT that is not preceded by a sinus pause.A and B,Tracings are continuous.(Cir 1991,84:1543);4、房性早搏;6、室性早博;;心房纤维颤动（房颤）;8、心房颤动;I;7、心房扑动;１