心动过速危害性的研究进展

心率受心脏自主神经系统功能的调控作用影响 ,人体心率在 2 4小时中呈现出一定的昼夜分布节律。一般在觉醒前 3小时 (即凌晨 0 3:0 0～ 0 6 :0 0 )达到谷值 ,觉醒后心率迅速上升 ,并于 3～ 6小时后 (上午 0 9:0 0～ 12 :0 0 )达到峰值[1～ 3] 。与心血管事件在这段时间多发相关。近年来许多学者对此研究发现 ,静息心率增快是心血管病的重要危险因素。静息时心动过速是心血管病发病率和死亡率的独立危险因素之一 ,又是重要的致病因素。如与肥胖、胰岛素抵抗、血脂增高、左室肥厚、高血细胞压积、高血糖等症状有关[4 ] 。1　心动过速与高血压…     

室上性心动过速的研究进展

２０世纪的上半叶 ,临床心脏电生理学逐渐得到广泛应用 ,提出了一系列重要概念 ,如缓慢传导、隐匿性传导、房室传导阻滞、心律失常形成的部位、异常激动的形成和折返等。１９３３年 ,Ｗｏｌｆｅｒｔｈ和Ｗｏｏｄ精确描绘了心室预激和环行运动性心动过速。４０～５０年代开展了心脏导管操作技术 ,记录到了希氏束(Ｈｉｓ)电位。１９６９年 ,Ｄｕｒｒｅｒ和Ｃｏｕｍｅｌ等人同时发明了心脏程序电刺激技术。１９７１年 ,Ｗｅｌｌｅｎｓ将程序电刺激技术和心内记录结合起来 ,使心脏电生理研究得到了巨大的飞跃。这就使人们能够通过心内导管标测技…     

心动过速性心肌病研究进展

心动过速性心肌病是继发于快速性心律失常并以心功能受损为突出临床表现的心肌病.相较于其他心肌病,其心功能在快速性心律失常得到控制后可部分或全部恢复.目前对其认识逐步深入,临床上早期诊断及病因治疗有重要意义.现就其致病因素、病理生理改变、临床特征及治疗作一综述.     

心动过速性心肌病的研究进展

心动过速性心肌病是一种可逆的扩张型心肌病,室性或室上性心动过速均可诱发,相关心动过速被终止后,患者心功能多可恢复正常。近几年随着导管消融技术的发展,大部分快速性心律失常可以得到根治,因此,明确诊断心动过速性心肌病更加重要。现虽然有很多文献报道心动过速性心肌病,我们对此病的认识仍很肤浅,仍有很多问题有待解决。本文就心动过速性心肌病相关研究已取得的进展及仍需解决的问题进行概述。     

心动过速性心肌病的研究进展

长期快速性心律失常可引起心室扩大和心室收缩功能障碍,即心动过速性心肌病。早期应用药物或导管消融可控制或消除心律失常,心脏扩大和心功能障碍可部分或完全恢复正常,即心动过速性心肌病是可逆性的。现就心动过速性心肌病的发病机制、诊断、治疗及预后作如下阐述。     

心动过速性心肌病研究进展

心动过速性心肌病指持续的、快速心律失常导致的心脏结构和心脏功能的异常,当心律失常得到有效控制,心脏扩大和心功能不全能够部分甚至全部恢复。1995年世界卫生组织和国际心脏病学会（WHO／ISFC）虽未把心动过速性心肌病列入分类中,但是在2008年欧洲心脏病学学会（ESC）发表的“心肌病分类共识”中将其归属于非家族性心肌病。即症状类似于家族性扩张型心肌病,不同的是持续的快速心律失常是心动过速性心肌病的促动因素,     

体位性心动过速综合征的研究进展

体位性心动过速综合征为一种直立不耐受伴心动过速的疾病。发病机制可能与中心低血容量及自主神经功能障碍有关。此外,血管活性介质（组织胺）释量增加以及肌泵功能缺陷亦起有重要作用。按体位性心动过速综合征亚型实施个体化给药方案,可获较好的疗效。     

心外膜室性心动过速的研究进展

导管消融室性心动过速(简称室速)已成为多数特发性室速首选的治疗策略。然而,对于器质性室速的消融研究中,发现心外膜室速发生率并不低,其消融的成功率较心内膜室速低,且并发症发生率相对较高。随着三维标测和消融技术日益完善及新型成像技术,如对比增强核磁共振、对比增强多排CT和正电子放射CT等显像技术的发展,增加了心外膜室速起源的心脏电解剖和成像解剖信息精确度与心外膜室速消融术成功率,其中以对比增强核磁共振的灵敏度和精确度最高。     

心动过速对心血管疾病危害的研究进展

心率受心脏自主神经系统功能的调控作用影响,人体心率在24h中呈现出一定的昼夜分布节律。一般在觉醒前3h(即凌晨03:00～06:00)达到谷值,觉醒后心率迅速上升并于3～6h后(上午09:00～12:00)达到峰值[1～3]。与心血管事件在这段时间多发相关。近年来许多学者对此研究发现,静息心率     

心动过速性心肌病的诊治研究进展

<正>心动过速性心肌病(tachycardia induced cardiomyopathy,TICM)是指长期的快速规则或不规则的房性心律失常,或快速室性心律失常导致的过快心室率,引起心脏扩大、心功能不全等临床表现的心肌疾病,属于继发性(获得性)心肌疾病,在心律、心率得到控制后,心脏结构和功能可以部分或全部恢复。Gossage等于1913年首次报道一例由快速心室率引起的心肌病患者,此后TICM一直有报道和研究。Fenelon等[1]根据心脏结构正常与否将TICM分为两种类型:1.单纯型,是指在无基础心脏病的病人中,     

Ventricular Tachycardia in Coronary Artery Disease

Ventricular arrhythmias are important contributors to morbidity and mortality in patients with coronary artery disease. Ventricular fibrillation accounts for the majority of deaths occurring in the acute phase of ischemia, whereas sustained, monomorphic ventricular tachycardia due to reentry generated in the scar tissue develops most often in the setting of healed myocardial infarction, especially in patients with lower left ventricular ejection fraction. Despite determinant advances in population education and myocardial infarction management, the ventricular tachycardia risk in the overall population with coronary artery disease continues to be a major problem in clinical practice. The initial evaluation of a patient presenting with ventricular tachycardia requires a 12-lead electrocardiogram, which can be helpful to confirm the diagnosis, suggest the presence of potential underlying heart disease, and identify the location of the ventricular tachycardia circuit. An invasive electrophysiologic study is usually crucial to determine the mechanism of the arrhythmia once induced and to provide guidance for ablation. The approach for ventricular tachycardia ablation depends on several factors, including inducibility, sustainability, and clinical tolerance of ventricular tachycardia. The paper also reviews other therapeutic options for patients with ventricular tachycardia associated with coronary artery disease, including antiarrhythmic drug therapy, surgical ablation, and current implantable cardioverter-defibrillator indications.     

85例2型糖尿病合并心脑血管疾病的临床治疗分析

目的对2型糖尿病合并心脑血管疾病的高危因素进行分析,并为临床疗效提供参考指导。方法对该院在2012年4月—2013年5月接收的160例2型糖尿病合并心脑血管疾病患者进行回顾性分析,根据患者是否存在合并心血管疾病对患者进行观察组和对照组的划分,观察组中的85例患者均为糖尿病合并心脑血管疾病,对照组中的75例均无心脑血管疾病,对两组患者饮食和吸烟、运动以及血糖的变化情况进行观察和分析。结果通过将两组患者的饮食控制情况进行对比可以看出,对照组的控制情况明显高于观察组,其观察组中的高糖和高脂饮食占比明显高于对照组,而已素食为主的比率明显低于对照组,将两组进行对比差异具有统计学意义(P0.05);将两组患者的运动情况和吸烟情况以及血糖控制情况进行对比分析,观察组中的患者运动次数少于对照组,而吸烟史则明显高于对照组,在其空腹和餐后2 h的血糖控制达标情况比对照组明显偏低,两组相比差异具有统计学意义(P0.05)。结论饮食、吸烟以及运动情况等都是造成2型糖尿病合并心脑血管疾病的重要因素,因此其病患者进行治疗的过程中需要对其加强健康教育,并让其能积极进行饮食的控制,戒烟的同时加强对身体的锻炼。     

Catheter Ablation for Ventricular Tachycardia in Structural Heart Disease

The management of ventricular tachyarrhythmias has changed significantly over the past several decades. The advent of readily available implantable cardioverter defibrillators (ICDs) has had the greatest effect, with important mortality effects in patients with ventricular tachycardia and structural heart disease. ICDs have been shown to reduce sudden death in patients with ischemic and nonischemic cardiomyopathies; evidence of adverse consequences of ICD shocks, however, is mounting. In addition to the negative effects on patient-reported quality of life, anxiety, and depression, frequent ventricular arrhythmias and ICD shocks have also been associated with increased mortality. It is therefore important to identify and implement effective ventricular tachycardia-suppressive strategies. Antiarrhythmic drugs represent one such method, but are challenged by unfavourable side effect profiles and proarrhythmic risk. Catheter ablation of ventricular tachycardia is now a well-accepted intervention, which has been demonstrated to reduce recurrent arrhythmias. Questions persist regarding the optimal role for ablation compared with drug therapy.     

Cardio-vascular effects of sildenafil: new data

Sildenafil is an inhibitor of phosphodiesterase 5, which has important vasodilatory properties. Though sildenafil provokes a decrease in systemic arterial pressure, its safety has been confirmed in large series of patients on several kinds of anti-hypertensive therapy. Likewise, post-marketing surveys, in the US or United Kingdom, have recorded a number of cardio-vascular deaths following sildenafil administration which was lower than expected, provided the contra-indication with the concomitant use of nitrates is observed. In patients with known or suspected coronary artery disease, sildenafil does not modify the tolerance or results of echocardiographic exercise testing. However, sildenafil does increase coronary flow reserve, both in narrowed or normal coronary arteries, with no sign of a "steal" phenomenon. Because of its capacity to retard the degradation of cGMP, by the inhibition of phosphodiesterase 5, the effect of sildenafil in primary pulmonary hypertension has been evaluated in several studies: acutely, sildenafil decreases pulmonary artery pressure, either alone or in combination with inhaled iloprost or NO. On the same line, sildenafil decreases hypoxia-induced pulmonary hypertension in normal volunteers. These findings, together with reports of long-term improvement in symptoms and levels of pulmonary artery pressure in patients with primary pulmonary hypertension, will warrant further trials to document its potential role in this otherwise severe disease.     

哇巴因与高血压心血管重塑

随着对高血压发生、发展的深入研究,认为现代治疗的策略不仅局限于降低血压,更重要的是靶器官保护.因此高血压引起的心血管重塑正逐渐成为研究热点.     

Intra-Atrial Reentrant Tachycardia After Palliation of Congenital Heart Disease:

Catheter Mapping of IART. introduction: The anatomic substrate of intra-atrial reentrant tachycardia (IART) following congenital heart surgery is poorly understood, but is presumed to be different than common atrial flutter. Methods and Results: To study the mechanisms of IART, we used a new technique for high-density endocardial mapping using recordings from a multipolar basket recording catheter (25 bipolar pairs). For each recording, biplane fluorographic reference points were digitized to obtain the spatial locations of electrode pairs, and activation times were calculated using temporal reference points from the surface ECG. Using custom software, data were combined to create three-dimensional atrial activation sequence maps, which were displayed as animated sequences. Using this technique, recordings were made in induced and/or spontaneous IART in 8 patients following congenital heart surgery (5 Fontan, 2 tetralogy of Fallot repair, 1 ventricular septal defect repair), and in 3 patients with normal intracardiac anatomy (I with type I atrial flutter). Ten discrete IART activation sequences were recorded; 2 patients had 2 sequences each. IART maps were constructed using a median of 108 electrode positions (range 27 to 197) from a median of 6 recordings/sequence (range 3 to 11). Sinus or paced atrial rhythms were also recorded, and maps were created in a similar fashion. Visual analysis of activation sequences of sinus and paced rhythm were anatomically concordant with known mechanisms of atrial activation. IART sequences revealed diverse mechanisms; only 1 IART circuit was similar to that associated with common atrial flutter. Activation wavefront emergence from presumed zones of slow conduction, lines of conduction block, and apparent bystander activation were observed. Conclusions: High-density atrial activation sequence maps demonstrate that IART following congenital heart surgery utilizes diverse circuits and is distinct from common atrial flutter. The technique used to create these three-dimensional activation sequences may improve understanding of these complex atrial arrhythmias and assist in the development of ablative therapies.