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1、<p><p>&lt;p&gt;&amp;lt;p&amp;gt;Arrhythmia 心律失常 2010 年 7 月 babala 1 Definition ?Arrhythmia （cardiac arrhythmia）are disorders of impulse formation and （or） conduction. ?The normal beat originated from sinus sinus node. Usually, the frequency of wave
2、s ranges was 60 to 100 per minute, which is regular day and night. The impulse agits auricles and ventricles through the atrioventricular conduction system(AVCS) at the normal sequence. ?For adults, time is fixed , usually 0.12 to 1.21 sec. Furthermore , the time of comduction from Purkinjes fibers
3、to ventricular muscles is also fixed，usually less than 0.1 ms。 Impulse 冲动，搏动 sinus node 窦房结 Auricle 心房 Ventricle 心室 AVCS 房室传导系统 Atrioventricular 房室的 New word book 2 心律失常的定义 ?心律失常是指心律起源和（或）心搏传导异常。 ?正常心律起源于窦房结，频率范围为60次100次/分钟 ，比较规则。窦房结冲动经正常房室传导系统顺序激动 心房和心室。 ?对成人而言，传导时间是恒定的，为0.121.21秒。同 时，冲动经浦肯野纤维到达心室肌
4、的传导时间也是恒定 的，通常小于0.10秒。 3 心脏解剖概图 myocardium 心肌 摘自第16版哈里逊内科学英文版，1311页 4 ANATOMY OF THE CONDUCTING SYSTEM ?Under normal conditions, the pacemaker function of the heart resides in the sinoatrial (SA)node,which lies at the junction of the right atrium and superior vena cava . ?Once the impulse exits the
5、sinus node, it traverses the atrium until it reaches the atrioventricular (AV)node. ?The SA node is 1.5 cm long and 2 to 3 mm wide and is supplied by the sinus node artery, which arises from either the right coronary artery (60%)or the left circumflex coronary artery (40%). The blood supply of the A
6、V node is derived from the posterior descending coronary artery (90%). New word book pacemaker 起搏点 atrium 心房 superior vena cava 上腔静脉 coronary 冠状的 posterior 后面的 derived from 得到 anatomy 解剖学 5 传导系统的解剖学 ?正常状态下，心脏起搏功能位于窦房结，即右心房 与上腔静脉的交界处。 ?冲动一离开窦房结，就经由心房到达房室结。 ?窦房结1.5厘米长，2至3毫米宽，由右冠状动脉窦房 结支供养，右冠状动脉窦房结支60%
7、起源于右冠状 动脉，40%起源于冠状动脉左旋支。 6 ANATOMY OF THE CONDUCTING SYSTEM ?The AV node lies at the base of the interatrial septum just above the tricuspid annulus and anterior to the coronary sinus. The electrophysiologic properties of the AV node result in slow conduction, which is responsible for the normal del
8、ay in AV conduction。 ?The SA node, atrium, and AV node are significantly influenced by autonomic tone. Vagal influences depress automaticity of the SA node, depress conduction, and prolong refractoriness in the tissue surrounding the SA node。Sympathetic influences exert the opposite effect。 New word
9、 book Vagal 迷走神经的 tricuspid annulus 三尖瓣环 refractoriness 不应性 interatrial 心房间的 septum 瓣膜 Sympathetic 交感神经的 7 传导系统的解剖学 ?房室结的血供90%是由冠状动脉后降支分出。 ?房室结位于房间隔的基底部，三尖瓣环的上部和冠状窦的前部 ?房室结的电生理特质导致了此处的慢传导，这就是心室传导正 常延迟产生的根源。 ?窦房结、心房和房室结都受自动节律性的影响。 迷走神经的影响减弱窦房结的自动节律性，减弱传导，并且延 长窦房结周围组织的不应期。交感神经的影响则是相反的。 8 Classificatio
10、n ?disorders of impulse conduction New word book Ectopic 异位性的 Sinus 窦性的 sinus arrhythmias ectopic arrhythmias ?disorders of impulse formation physiologic disorders of AV conductive pathway pathologic Physiologic 生理性的 pathologic 病理性的 9 Disorders of impulse formation ? (一)passive ectopic arrhythmias e
11、scape beats ascape rhythm ?(二)automatic ectopic arrhythmias ?premature beat ?paroxysmal tachycardia ?tachycardia atrial flutter ventricular flutter atrial fibrillation ventricular fibrillation New word book paroxysmal 阵发性的 fibrillation 纤维性颤动 flutter 摆动 tachycardia 心动过速 premature 过早的 10 冲动形成异常 ?被动性异位
12、心律 ?逸搏 (房性、房室交界性、室性） ?逸搏心律 (房性、房室交界性、室性） ?主动性异位心律 ?期前收缩(早搏) （ 房性、房室交界性、室性） ?阵发性心动过速 （房性、房室交界性、房室折返性、室性） ?房扑 ?室扑 ?房颤 ?室颤 返回 11 Disorders of impulse conduction ?physiologic interference and atrioventricular dissociation ?pathologic sinoatrial block； intra-atrial/intraventricular block atrioventricular
13、 block bundle branch block/fascicular block ?disorders of AV conductive pathway preexcitiation syndrome New word book preexcitiation 预激发 dissociation 分离 fascicular 成束的 返回 12 冲动传导异常 ?生理性： 干扰及房室分离 ?病理性： 窦房传导阻滞 房内传导阻滞 或者 室内传导阻滞 房室传导阻滞 束支或分支阻滞 ?房室间传导途径异常 预激综合征 13 常见的窦性心律失常 ?sinus arrhythmias 窦性心律不齐 ?sin
14、us bradycardia 窦性心动过缓 ?sinus tachycardia 窦性心动过速 ?sinus pause or sinus arrest 窦性间歇或窦性停搏 ?sick sinus syndrome (SSS) 病态窦房结综合症 返回 14 Premature bests 期前收缩 ?ectopic pacemaker site send out premature bests 异位起搏点提前起搏 ?atrial premature beat 房性期前收缩 ?junctional premature beat 交界性期前收缩 ?ventricular premature bea
15、t 室性期前收缩 返回 15 Tachycardia 心动过速 ?Tachycardias refer to arrhythmia at rates exceeding 100 beats/min，they occur more often in structurally diseased than in normal hearts. ?Classification atrial tachycardia 房性心动过速 super ventricular tachycardia 室上性心动过速 ventricular tachycardia 室性心动过速 torsades de points v
16、entricular tachycardia 尖端扭转型室速 16 Tachycardia 心动过速 ?atrial flutter 心房扑动 ?ventricular flutter 心室扑动 ?atrial fibrillation 心房纤颤 ?ventricular fibrillation 心室纤颤 阅读 17 ATRIAL FIBRILLATION 心房纤颤 ?AF is characterized by disorganized atrial activity without P waves on the ECG，the Atrial activation is presented
17、 by sharply waves and frequency ranging from 350 to 600 beats/min. ?The paroxysmal form may be seen in normal individuals, particularly during emotional stress or following surgery, exercise, or acute alcoholic intoxication. ?It may also occur in patien&amp;lt;/p&amp;gt;&lt;/p&gt;</p></p>
