Arrhythmia
Introduction
Introduction Arrhythmia is caused by dysfunction or activation of sinus node sinus outside the sinus node, stimuli conduction slow, block or conduction through abnormal channels, ie the origin of cardiac activity and/or the conduction disorder causes the frequency of heart beats and (or The rhythm is abnormal. Arrhythmia is an important group of diseases in cardiovascular disease. It can be associated with cardiovascular disease alone or in combination with cardiovascular disease. Sudden onset and sudden death, can also continue to affect the heart and fail. The clinical manifestations of hemodynamic changes in arrhythmias depend primarily on the nature, type, cardiac function, and extent of hemodynamic effects of arrhythmias.
Cause
Cause
Arrhythmia can be seen in a variety of organic heart disease, including coronary atherosclerotic heart disease (referred to as coronary heart disease), cardiomyopathy, myocarditis and rheumatic heart disease (referred to as rheumatic heart disease) is more common, especially in the occurrence of heart Arrhythmias in patients with basic health or autonomic dysfunction are not uncommon in patients with debilitating or acute myocardial infarction. Other causes are electrolyte or endocrine disorders, anesthesia, hypothermia, thoracic or cardiac surgery, drug effects, and central nervous system. Some diseases are unknown, such as diseases.
Examine
an examination
Related inspection
Pleural effusion check cardiopulmonary exercise test (CPET) serum creatine kinase serum albumin to globulin ratio (A/G) creatine kinase
Electrocardiogram
Electrocardiogram recording during the onset of arrhythmia is an important basis for the diagnosis of arrhythmia. Longer II or V1 lead records should be included. Pay attention to the P and QRS wave morphology, P-QRS relationship, PP, PR and RR interval, and determine whether the basic heart rhythm is sinus or ectopic. When the chamber is independent, find out the origin of the P-wave and QRS complexes (selection II, aVF, aVR, V1, and V5, V6 leads). When the P wave is not obvious, try to increase the voltage or speed up the paper speed, and make a long record of the lead with obvious P wave. If necessary, the P wave can also be displayed using the esophageal lead or the right atrial electrogram. Through the above methods, consciously search for QRS, ST and T waves, but when there is no P wave, consider atrial fibrillation, flutter, atrioventricular junction rhythm or atrial pause. The nature of the arrhythmia is finally judged by analyzing the nature and source of the heartbeat early or delayed.
2. Dynamic ECG
The 24-hour continuous ECG recording may record the onset of arrhythmia, the effects of the autonomic nervous system on spontaneous arrhythmias, the relationship between perceived symptoms and arrhythmias, and assess the therapeutic effect. However, it is difficult to record arrhythmia that is infrequent.
3. Invasive electrophysiological examination
In addition to the diagnosis of slow arrhythmia and tachyarrhythmia, it can also be used to determine the function of sinoatrial node and atrioventricular conduction system in the intermittent application of arrhythmia, induce supraventricular and ventricular tachyarrhythmia, and determine the heart rhythm. The site of abnormal origin, evaluation of the effects of drugs and non-drugs, and the provision of necessary information for surgery, pacing or ablation.
4. Average ECG
Also known as high-resolution surface electrocardiogram, the ventricular late potential of local myocardial delayed depolarization caused by the extension of the ventricular ventricular myocardium can be recorded on the body surface. The presence of ventricular late potential provides a favorable basis for the formation of reentry, and thus the risk of ventricular tachycardia, ventricular fibrillation and sudden death is correspondingly increased in patients with ventricular late potential.
5. Exercise test
Exercise tests may induce arrhythmias during intermittent arrhythmia and thus contribute to the diagnosis of intermittent arrhythmias. Exercise-induced ventricular tachycardia after antiarrhythmic drugs (especially drugs that cause slower conduction in the heart) may be a manifestation of drug-induced arrhythmia.
Diagnosis
Differential diagnosis
It should be differentiated from the following symptoms:
1. supraventricular arrhythmia
Rapid supraventricular arrhythmia is a clinically common cardiovascular emergency, including various supraventricular tachycardia and atrial flutter, atrial fibrillation. The clinical treatment measures have been improved, including invasive treatment methods such as vagus nerve stimulation, electric shock cardioversion, drug treatment and radiofrequency ablation, which can basically control all seizures, and many of them can still achieve the goal of radical cure.
2. Atrial premature beats
Atrial prematurebeats, referred to as atrial premature, originate from any part of the atrium outside the sinus node. Normal adults underwent 24-hour ECG monitoring, and approximately 60% had premature ventricular development. A variety of organic heart disease can occur in people with early onset, and often a precursor to rapid atrial arrhythmias.
3. Cardiac arrest
Cardiac arrest means that the myocardium still has bioelectrical activity, and there is no effective mechanical function. There is a slow, very weak and incomplete "shrinkage" condition. There are intermittently wide, deformed, low amplitude QRS waves on the electrocardiogram. Groups, the frequency is more than 20 to 30 times per minute. At this time, the myocardium has no contraction and blood discharge function, and the heart sound is not heard when the heart is auscultated, and the peripheral arteries are not beaten.
