内科护理学课件 英语 考试资料dysrhythmias-文档资料.ppt
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1、Properties of cardiac tissue 心脏组织的特性 Automaticity 自律性: ability to initiate an impulse spontaneously and continuously. Excitability兴奋性: ability to be electrically stimulated. Contractility收缩性: ability to respond mechanically to an impulse. Conductivity传导性: ability to transmit an impulse along a membr
2、ane in an orderly manner. Conduction system: a brief review传导系统 P wave begins with the firing of the SA node and represents depolarization 去极化 of the fibers of the atria心房, resulting in atrial contraction心房收缩. The QRS complex represents depolarization 去极化 of the ventricles心 室, resulting in ventricul
3、ar contraction心室收缩. The T wave represents repolarization复极of the ventricles心室, or the time at which the ventricles return to the prestimulated state. Conduction system: a brief review Intervals波间隔between these waves reflects the lengths of time it takes for the impulses to travel from one area of th
4、e heart to the other. The PR interval represents the period during which the impulse spreads through the atria, AV node房室结, bundle of His希氏束, and Purkinje浦肯野纤维 . The QRS interval represents the time it takes for depolarization去 极化of both ventricles. The QT interval represents the time it takes for c
5、omplete depolarization除极and repolarization复极of the ventricles. Dysrhythmia Dysrhythmia is an abnormal cardiac rhythm in terms of the frequency of the impulse频率, rhythm节律, origin site起源部位, conduction velocity传导速度and excitement order激动次序. Classification of Dysrhythmia 心律失常的分类 Abnormal impulse formatio
6、n 冲动形成异常 sinus dysrhythmia 窦性心律失常 sinus tachycardia窦性心动过速 sinus bradycardia窦性心动过缓 窦性心律不齐 sinus arrest窦性停搏 ectopic rhythm异位心律 Passive ectopic rhythm被动性异 位心律 Escaped 逸博 Escapedrhythm 逸博心律 Active ectopic rhythm主动性异 位心律 期前收缩Premature Contraction Paroxysmal tachycardia阵发性 心动过速 atrial flutter房扑, atrial fi
7、brillation房颤 ventricular flutter室扑, ventricular fibrillation室颤 Abnormal impulse comduction 冲动传导异常 Physiological:生理性: interference and separation of AV 干扰和房室分离 pathological病理性: block of SA窦房传导阻滞 block of atrial pathway房内传 导阻滞 block of atrioventricular pathway房室传导阻滞 Block of bundle branch束支或 分支阻滞或室内阻滞
8、 房室间传导途径异常:WPW 预激 综合征 Sinus tachycardia窦性心动过速 Clinical association: It associated with physiological stressors such as exercise, fever, pain, anxiety, hypotension, hypovolemia低血容量 , anemia, hypoxemia低氧血症 , hypoglycemia低血糖症 , myocardial ischemia, CHF, and thyrotoxicosis甲状腺毒症. It also can be affected
9、by drugs such as epinephrine, norepinephrine, caffeine, atropine阿托品 , theophylline茶硷 , nifedipine硝苯地平 , hydralazine胼酞嗪 (降压 药) Sinus tachycardia窦性心动过速 Significance: The clinical significance of sinus tachycardia depends on patients tolerance of the increased HR. The patient may have symptoms of dizzi
10、ness头 晕, hypotension低血压may occur. Angina or an increase in infarct size may accompany persistent sinus tachycardia in the patient with MI心肌梗塞. Treatment The treatment is determined by underlying causes. In certain setting, -blocker therapy is used to reduced HR and decrease myocardial oxygen consump
11、tion. Sinus tachycardia ECG characteristics HR is greater than 100 bpm, rhythm is regular. The P wave is normal, precedes each QRS complex, and has a normal contour and fixed interval. The PR interval is normal and the QRS complex has a normal contour. Sinus bradycardia 窦性心动过缓 Clinical association 临
12、床联系: It occurs in response to hypothermia低体温 , carotid sinus massage按压颈动脉窦, increased intraocular pressure眼内压 , increased vagal tone迷走神经紧张 , and administration of parasympathomimetic拟副 交感神经药 drugs. Diseases states associated with sinus bradycardia are hypothyroidism 甲状腺机能 减退 , increased intracranial
13、 pressure颅内压 , obstructive jaundice阻塞性黄疸 and inferior wall MI. Sinus bradycardia 窦性心动过缓 Significance意义: The clinical significance of sinus bradycardia depends on how the patients tolerates it hemodynamically. Hypotension with decreased CO may occur in some circumstances. Treatment治疗: for the patient
14、 with symptoms, administration of atropine 阿托品 , and anticholinergic drug抗胆碱能药 . Pacemaker therapy may be required. Sinus bradycardia窦性心动过缓 ECG characteristics HR is less than 60 bpm, rhythm is regular. The P wave precedes each QRS complex. The PR interval is normal and the QRS complex has a normal
15、contour and normal length. Premature Atrial Contraction (PAC)房性期前收缩 A PAC is a contraction originating from an ectopic focus异位病灶 in the atrium in a location other than the sinus node. It originates in the left or right atrium and travels across the atria by an abnormal pathway, creating a distorted
16、P wave. At the AV node房室结, it is stopped (nonconducted PAC), delayed (lengthened PR interval), or conducted normally. It moves through the AV node, and in most cases, it is conducted normally through the ventricles. Premature Atrial Contraction (PAC)房性期前收缩 Clinical association In a normal heart, it
17、can result from stress or the use of caffeine, tobacco or alcohol. It also can result from diseases states such as infection, inflammation, hyperthyroidism甲亢, COPD, heart diseases, valvular diseases. A PAC and also be caused by enlarged atria. Significance: a PAC may be prelude前奏to supraventricular
18、tachycardias室上性心动过速. Treatment: depends on patients symptoms. Withdrawal of sources of stimulation such as caffeine may be warranted. Drugs such as digoxin, quinidine奎尼丁, , procainamide普鲁卡因, flecainide氟卡尼 , and - blockers can be used. Premature Atrial Contraction (PAC)房性期前收缩 ECG characteristics HR v
19、aries and rhythm is irregular. The P wave may be notched缺迹 or have negative deflection逆向 的偏转, or it may be hidden in the preceding T wave. QRS is usually normal, if the QRS interval is 0.10 second or longer, abnormal conduction through the ventricle is present. The PR interval may be shorter or long
20、er than normal PR interval, but its within normal limit. Paroxysmal supraventricular tachycardia (PSVT) 阵发性室上性心动过速 PAVT is dysrhythmia originating in an ectopic focus anywhere above the bifurcation of the bundle of His希氏束 分支. PSVT occurring via an accessory pathway旁路途径is designated as orthodromic顺向o
21、r antidromic逆向性 tachycardia. Paroxysmal supraventricular tachycardia (PSVT) 阵发性室上性心动过速 Orthodromic顺向refers to anterograde顺时, or forward 向前conduction through the AV node and retrograde逆行, backward 向后 conduction, through the accessory pathway. Antidromic逆向refers to the opposite: anterograde conduction
22、 顺时传导through the accessory path 旁路途径 and retrograde conduction 逆行传导 through the AV node. Paroxysmal supraventricular tachycardia (PSVT) 阵发性室上性心动过速 Clinical association In the normal heart, PSVT is associated with overexertion, emotional stress, changes of position, deep inspiration, and stimulation
23、and stimulants such as caffeine and tobacco. In a diseases state, PSVT is associated with rheumatic heart disease, Wolff-Parkinson- White (WPW)预激综合症(conduction via accessory pathways), digitailis intoxication, coronary artery disease or cor pulmonary. Paroxysmal supraventricular tachycardia (PSVT) 阵
24、发性室上性心动过速 Significance: a prolonged episode and HR greater than 180 bpm may precipitate a decreased CO with hypotension and myocardial ischemia. Treatment: vagal stimulation迷走神经刺激: carotid massage按 摩颈动脉窦or the Valsalva meneuver Valsalva动作 pharmacologic therapy: adenosine腺苷 , verapamil 异搏定 , diltiaze
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