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Propertiesofcardiactissue心脏组织的特性
Automaticity自律性:abilitytoinitiateanimpulsespontaneouslyandcontinuously.
Excitability兴奋性:abilitytobeelectricallystimulated.
Contractility收缩性:abilitytorespondmechanicallytoanimpulse.
Conductivity传导性:abilitytotransmitanimpulsealongamembraneinanorderlymanner.
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Conductionsystem:abriefreview传导系统
PwavebeginswiththefiringoftheSAnodeandrepresentsdepolarization去极化ofthefibersoftheatria心房,resultinginatrialcontraction心房收缩.
TheQRScomplexrepresentsdepolarization去极化oftheventricles心室,resultinginventricularcontraction心室收缩.
TheTwaverepresentsrepolarization复极oftheventricles心室,orthetimeatwhichtheventriclesreturntotheprestimulatedstate.
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Conductionsystem:abriefreview
Intervals波间隔betweenthesewavesreflectsthelengthsoftimeittakesfortheimpulsestotravelfromoneareaofthehearttotheother.
ThePRintervalrepresentstheperiodduringwhichtheimpulsespreadsthroughtheatria,AVnode房室结,bundleofHis希氏束,andPurkinje浦肯野纤维.
TheQRSintervalrepresentsthetimeittakesfordepolarization去极化ofbothventricles.
TheQTintervalrepresentsthetimeittakesforcompletedepolarization除极andrepolarization复极oftheventricles.
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Dysrhythmia
Dysrhythmiaisanabnormalcardiacrhythmintermsofthefrequencyoftheimpulse频率,rhythm节律,originsite起源部位,conductionvelocity传导速度andexcitementorder激动次序.
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ClassificationofDysrhythmia心律失常的分类
Abnormalimpulseformation冲动形成异常
sinusdysrhythmia窦性心律失常
sinustachycardia窦性心动过速
sinusbradycardia窦性心动过缓
窦性心律不齐
sinusarrest窦性停搏
ectopicrhythm异位心律
Passiveectopicrhythm被动性异位心律
Escaped逸博
Escapedrhythm逸博心律
Activeectopicrhythm主动性异位心律
期前收缩PrematureContraction
Paroxysmaltachycardia阵发性心动过速
atrialflutter房扑,atrialfibrillation房颤
ventricularflutter室扑,ventricularfibrillation室颤
Abnormalimpulsecomduction冲动传导异常
Physiological:生理性:interferenceandseparationofAV干扰和房室分离
pathological病理性:
blockofSA窦房传导阻滞
blockofatrialpathway房内传导阻滞
blockofatrioventricularpathway房室传导阻滞
Blockofbundlebranch束支或分支阻滞或室内阻滞
房室间传导途径异常:WPW预激综合征
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Sinustachycardia窦性心动过速
Clinicalassociation:
Itassociatedwithphysiologicalstressorssuchasexercise,fever,pain,anxiety,hypotension,hypovolemia低血容量,anemia,hypoxemia低氧血症,hypoglycemia低血糖症,myocardialischemia,CHF,andthyrotoxicosis甲状腺毒症.
Italsocanbeaffectedbydrugssuchasepinephrine,norepinephrine,caffeine,atropine阿托品,theophylline茶硷,nifedipine硝苯地平,hydralazine胼酞嗪(降压药)
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Sinustachycardia窦性心动过速
Significance:Theclinicalsignificanceofsinustachycardiadependsonpatient’stoleranceoftheincreasedHR.
Thepatientmayhavesymptomsofdizziness头晕,hypotension低血压mayoccur.
AnginaoranincreaseininfarctsizemayaccompanypersistentsinustachycardiainthepatientwithMI心肌梗塞.
Treatment
Thetreatmentisdeterminedbyunderlyingcauses.
Incertainsetting,β-blockertherapyisusedtoreducedHRanddecreasemyocardialoxygenconsumption.
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Sinustachycardia
ECGcharacteristics
HRisgreaterthan100bpm,rhythmisregular.
ThePwaveisnormal,precedeseachQRScomplex,andhasanormalcontourandfixedinterval.
ThePRintervalisnormalandtheQRScomplexhasanormalcontour.
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Sinusbradycardia窦性心动过缓
Clinicalassociation临床联系:
Itoccursinresponsetohypothermia低体温,carotidsinusmassage按压颈动脉窦,increasedintraocularpressure眼内压,increasedvagaltone迷走神经紧张,andadministrationofparasympathomimetic拟副交感神经药drugs.
Diseasesstatesassociatedwithsinusbradycardiaarehypothyroidism 甲状腺机能减退,increasedintracranialpressure颅内压,obstructivejaundice阻塞性黄疸andinferiorwallMI.
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