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題 名 | Complex Arrhythmia=複雜性心律不整 |
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作 者 | 江晨恩; 陸翔寧; | 書刊名 | 中華民國重症醫學雜誌 |
卷 期 | 1:1 1999.10[民88.10] |
頁 次 | 頁32-50 |
分類號 | 415.318 |
關鍵詞 | 心律不整; 心室頻脈; 心室上頻脈; 沃爾夫帕金森懷特氏症候群; QT延長症候群; 多型性心室頻脈; 促心律不整作用; Complex arrhythmia; Ventricular tachycardia; Supraventricular tachy-cardia; Wolff-parkinson-white syndrome; Long QT syndrome; Torsade de pointes; Brugada syndrome; Proarrhythmia; |
語 文 | 英文(English) |
中文摘要 | 複雜的心律不整對內科醫師及心臟科醫師都是極大的挑戰。錯誤的診斷會造成錯誤的治療,而導致病人生命的危險。雖然臨床上已有一些準則可用以診斷心律不整,但錯誤的判讀仍屢見不鮮,這主要是因為對這些複雜的心律不整認知不足,再加上錯誤的治療所致。寬QRS波型頻脈常常在急診室裡造成困擾。它包括心室頻脈、心室上頻脈合併支束傳導阻斷、心室上頻脈合併心室早發症候群。它的正確診斷有賴於對心電生理徹底的瞭解,而現有一些心電圖準則可用以鑑別診斷。先天性QT延長症候群引起的一種多型性心室頻脈,稱為torsade de pointes,是另一種複雜的心律不整常常引起猝死, 而且常發生在年輕人身上。臨床醫師必須有警覺才能及早診斷。而由其他藥物,包括抗心律不整藥物,尤以鈉離子阻斷劑,鉀離子阻斷劑及毛地黃所引起之促心律不整作用,常常是以特殊的心律不整來表現,更有賴於高度的警覺性以及早發現。本文將對這些複雜的心律不整其致病電生理機轉、診斷及治療作一探討。 |
英文摘要 | Complex cardiac arrhythmias are challenging for both physicians and cardiologists. An incorrect diagnosis can lead to inappropriate therapy and potentially lethal consequences. Despite the availability of defined clinical and electrocardiographic criteria, the underlying rhythm is often misdiagnosed. This is mainly due to lack of awareness of specific arrhythmias and the ability to provide appropriate therapy Wide QRS tachycardia is a frequently encountered arrhythmia in the emergency room, usually causing trouble for physicians to make correct differential diagnosis. It includes ventricular tachycardia, supraventricular tachycardia with aberrancy, and preexcited supraventricular tachycardia. Correct diagnosis depends on a detailed examination of the ECG characteristics. There are a number of ECG criteria for reference that are absolutely required for making correct interpretation, a prerequisite for appropriate therapy. For patients presenting with hemodynamic instability, direct current cardioversion is indicated. Congenital long QT syndrome has been the subject of caused widespread interest in recent decades. It has been confirmed that genetic mutations cause structural and functional changes in the ionic channels on the cell membrane, resulting in a prolongation of action potential duration in the ventricular myocytes and hence a prolonged QT interval. A specific form of polymorphic ventricular tachycardia, torsade de pointes, has been recognized, as a hallmark for patients with congenital long QT syndrome, and it should not be missed in young patients with syncope or aborted sudden death. The importance of proarrhythmia due to antiarrhythmic agents and other non-cardiovascular medications needs to be emphasized as well, since prompt recognition and immediate discontinuation of the offending agents is the keystone of the successful management. The pathophysiology, diagnosis, and management of these complex arrhythmias will be addressed in this article. |
本系統中英文摘要資訊取自各篇刊載內容。