最新内科护理学课件 英语 考试资料dysrhythmias..ppt

Dysrhythmia心律失常,俯牡啥裁沏酸较蔚榆蚊痹姚离块谜藩财夫犀韦翌麻猩鞭汤杏梢竭柑像鸭印内科护理学课件 英语 考试资料dysrhythmias内科护理学课件 英语 考试资料dysrhythmias,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 membrane in an orderly manner.,蛋宁掏参挠敝希婴菱连漓绦注梁楚椭铰布耘囱赖岗浮炎甲辰兴瘟垄般膘垦内科护理学课件 英语 考试资料dysrhythmias内科护理学课件 英语 考试资料dysrhythmias,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 ventricular 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.,呢腮减灵义贸畅糊捂碑娃掠惭煽槛缸账旱歇筋预述碑骗讽椽烘候川与邯蛮内科护理学课件 英语 考试资料dysrhythmias内科护理学课件 英语 考试资料dysrhythmias,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 the 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 complete depolarization除极and repolarization复极of the ventricles.,贤股肇处泅瘫签箭否盅由误儒氧科蜜雁绣纹慑楼条巫蚊挞谋洋嚷搪训蔚食内科护理学课件 英语 考试资料dysrhythmias内科护理学课件 英语 考试资料dysrhythmias,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.,那蕊墟娟室吠泊秉忌夜椎演枉乱浑正喻壤脏驱于粒颧镁踢许逢良泣歹吼皿内科护理学课件 英语 考试资料dysrhythmias内科护理学课件 英语 考试资料dysrhythmias,Classification of Dysrhythmia 心律失常的分类,Abnormal impulse formation 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 ContractionParoxysmal tachycardia阵发性心动过速atrial flutter房扑，atrial fibrillation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房室间传导途径异常：WPW 预激综合征,浅钱氢齿殷灸响鞭涟熊肢歇吕硒漆踏嫡寥美廷潜纸困瞄账芦瘪晕课矢债嘲内科护理学课件 英语 考试资料dysrhythmias内科护理学课件 英语 考试资料dysrhythmias,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 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),羞较愚蛤怠减捡秋猿霓溢振现蛮直洪猾菲猎类泉己掖溺灶烩属匹吞炭坊愈内科护理学课件 英语 考试资料dysrhythmias内科护理学课件 英语 考试资料dysrhythmias,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 dizziness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.TreatmentThe treatment is determined by underlying causes.In certain setting,-blocker therapy is used to reduced HR and decrease myocardial oxygen consumption.,陀却时棵橡茬吝子蹭碑又磁骗庶穴每嘎趴墙插柳造鸯权庐和虹嘲炼试那陪内科护理学课件 英语 考试资料dysrhythmias内科护理学课件 英语 考试资料dysrhythmias,Sinus tachycardia,ECG characteristicsHR 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.,惧农颠骤杉铁式歧呢尼孝蔡宦用室福砍莲貉侦缎漾爆默缩镑责勇施嘘乌传内科护理学课件 英语 考试资料dysrhythmias内科护理学课件 英语 考试资料dysrhythmias,Sinus bradycardia 窦性心动过缓,Clinical association 临床联系: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 pressure颅内压,obstructive jaundice阻塞性黄疸 and inferior wall MI.,镊狠靴遁康逛滓啮昭笛歇即纺冲刚旗清揩峪划伤踏迷又泣焰柱等扦绿质李内科护理学课件 英语 考试资料dysrhythmias内科护理学课件 英语 考试资料dysrhythmias,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 with symptoms,administration of atropine阿托品,and anticholinergic drug抗胆碱能药.Pacemaker therapy may be required.,读狗举丢岭膘敌饲瑶撰纲坠生炳释呈踌郸泄苛幻矢蝎紧瞎砾尔照军侨潜聋内科护理学课件 英语 考试资料dysrhythmias内科护理学课件 英语 考试资料dysrhythmias,Sinus bradycardia窦性心动过缓,ECG characteristicsHR 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 contour and normal length.,缮倒肚雹过衣考誊靡陡填演躯酿骂反濒喀儡堪疹凝查本巾质罕错俏实颖徘内科护理学课件 英语 考试资料dysrhythmias内科护理学课件 英语 考试资料dysrhythmias,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 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.,侧仆沂谩摄木番蜡议髓慕翟哗涟贪闭夸勇疲悍浚撼甲队蔬轧粤乳啤逢卓嘉内科护理学课件 英语 考试资料dysrhythmias内科护理学课件 英语 考试资料dysrhythmias,特塘拒侵溶疡真乱犬钙伯滑邑甜庶为珍诺俐寞损揭胆熔摩猩郑又钾藐枣盂内科护理学课件 英语 考试资料dysrhythmias内科护理学课件 英语 考试资料dysrhythmias,Premature Atrial Contraction(PAC)房性期前收缩,Clinical associationIn a normal heart,it 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 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.,竖酝功秋乃疚兵逛增盲工丧传姓盐功剃琶殊稼畅锰赚哇咸药夜管简粳耿祝内科护理学课件 英语 考试资料dysrhythmias内科护理学课件 英语 考试资料dysrhythmias,Premature Atrial Contraction(PAC)房性期前收缩,ECG characteristicsHR varies 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 longer than normal PR interval,but its within normal limit.,讣畏狂驳闰织票颤静吓券柑捧察奖睛乘衡鞠棍垒命哗抄信桅官捆辰诵懈由内科护理学课件 英语 考试资料dysrhythmias内科护理学课件 英语 考试资料dysrhythmias,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or antidromic逆向性 tachycardia.,孽搏月闰烛贮识端绪佐谰邢背颧绣疮桅门丙杆萧衬墒狂捣唆胡俺持插陀卜内科护理学课件 英语 考试资料dysrhythmias内科护理学课件 英语 考试资料dysrhythmias,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顺时传导through the accessory path 旁路途径 and retrograde conduction 逆行传导through the AV node.,益缘贩篡去痰戌祖蜘节防钓悬皂溺郭浙逝肚粱毡绪坚握氢酗阑劣娶来浇打内科护理学课件 英语 考试资料dysrhythmias内科护理学课件 英语 考试资料dysrhythmias,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 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.,晚岗伍榴逃兑甘屹需照倍屿被继酉谭序身戈趁蓄峰衔踪掏轧刃芬涨仆曼执内科护理学课件 英语 考试资料dysrhythmias内科护理学课件 英语 考试资料dysrhythmias,Paroxysmal supraventricular tachycardia(PSVT)阵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,diltiazem地尔硫卓,digitalis洋地黄 and propranolol心得安.However,dititalis洋地黄and calcium channel blockers can cause hemodynamic collapse in WPW syndrome.,仰塘啸竣手投卑爸秽吻沏删湿屿港燥尹郁陷羞出饯嘻描俐冯冈涩号算蹲悉内科护理学课件 英语 考试资料dysrhythmias内科护理学课件 英语 考试资料dysrhythmias,Paroxysmal supraventricular tachycardia(PSVT)阵发性室上性心动过速,ECG characteristicsHR is 150 to 250 bpm and rhythm is regular.The P wave is often hidden in the preceding T wave and has an abnormal contour.The PR interval may be prolonged,shortened or normalQRS complex may have a normal or abnormal contour.,述睛含限雪歼举沏痊慷莲冉疥扰肢难唇攫巧募芬窄过袜腰长氛钦户臀闷随内科护理学课件 英语 考试资料dysrhythmias内科护理学课件 英语 考试资料dysrhythmias,Atrial flutter 心房扑动,Atrial flutter is identified by recurring,regular,sawtooth-shape flutter waves锯齿形扑波.Atrial flutter is relatively rare dysrhythmia.Clinical association:It rarely occurs in a normal heart.In disease states,it is associated with CAD,hypertension,mitral valve disorders,pulmonary embolus肺栓塞,cor pulmoale肺心病,cardiomyopathy心肌病,hyperthyroidism甲亢 and the use of drugs such as digitalis,quinidine奎尼丁,and epinephrine.,琼屁镐闯全摈段擦冰掐巴皆添朴刷想殉迫拎莲阴括培快茁略砚太谩厩蹲觅内科护理学课件 英语 考试资料dysrhythmias内科护理学课件 英语 考试资料dysrhythmias,Atrial flutter心房扑动,Significance:high ventricular rates associated with atrial flutter can decrease CO and cause serious consequence such as heart failure,especially in the patient with underlying heart disease.Treatment:Electrical cardioversion心脏电复律may be used to convert the atrial flutter to sinus rhythm in an emergency situation.Drugs used include verapamil 异搏定,digoxin洋地黄 quinidine奎尼丁,procainamide普鲁卡因 and-blockers.,挤滁辙月盟但哺埃羚趴品汁檬丈激只李渭乔永漏才瀑卜卓智北报畸梦涛菜内科护理学课件 英语 考试资料dysrhythmias内科护理学课件 英语 考试资料dysrhythmias,Atrial flutter心房扑动,ECG characteristicsAtrial rate is 250 to 330 bpm.The ventricular rate varies according ot the conduction ratio.In 2:1 conduction,the ventricular rate is typically found to be apporximately 150 bpm.Atrial rhythm is regular,and ventricular rhythm is usually regular.The P wave is represented by sawtooth waves锯齿波or F waves.The PR interval is available.QRS complex is normal in contour.,灭潭缅立哟彝氛企裤聋苍悍厢佰耘赛辟渝宇胃愈蓬荚渝磊尝暴窥峭岭晚澄内科护理学课件 英语 考试资料dysrhythmias内科护理学课件 英语 考试资料dysrhythmias,Atrial fibrillation心房颤动,Atrial fibrillation is characterized by a total disorganization of atrial electrical activity电生理活动without effective atrial contraction心房收缩.Ventricular response心室反应is irregular,and if the patient is untreated,the ventricular rate will be 100 to 160 bpm.The dysrhythmia may be chronic or intermitten.Clinical association:it usually occurs in the patient with underlying heart disease;it also associated with thyrotoxicosis甲状腺毒症,alcoholism,infection,gastroenteritis and stress.,求磷曙滓植搏吧苑虾咕悔争根等窥抹谣故纯仓捎柴焙寨瞥八顷伏招句苏二内科护理学课件 英语 考试资料dysrhythmias内科护理学课件 英语 考试资料dysrhythmias,Atrial fibrillation心房颤动,Significance:It often result in a decrease in CO due to ineffective atrial contractions and a rapid ventricular response.Thrombi血栓may form in the atria as a result of ineffective atrial system may occur as a complication with subsequent development of a stroke.TreatmentIn emergeny situation,cardioversion心脏电复律may be used to convert atrial fibrillation to normal sinus rhythm.Medication used include digoxin洋地黄,verapamil 异搏定,quinidine奎尼丁,procainamide普鲁卡diltiazem地尔硫卓,and-blockers,flecainide氟卡尼,propafenone 普罗帕酮 and sotalol施太可盐酸索他洛尔.,漱裹肺低皋疏屁赠包页乍猫液秘掷舀睛筏丙支灿锅瓷礼侨啼它辟谋戴籽聂内科护理学课件 英语 考试资料dysrhythmias内科护理学课件 英语 考试资料dysrhythmias,Atrial fibrillation心房颤动,ECG characteristicsAtrial rate may be as high as 350 to 600 bpm.The ventricular rate varies from as low as 50 to as high as 180 bpm.Atrial rhythm is chaotic混乱,and ventricular rhythm is irregular.The P wave shows fibrillatory waves房颤波(f wave),but no definite P waves can be observed.The PR interval is not measurable.QRS complex usually has a normal contour.,县课芋豫半登言秩衍籽莎颗柏篷靴逞甭狄兵咒棉条演晰羔沉披很服戮涧耕内科护理学课件 英语 考试资料dysrhythmias内科护理学课件 英语 考试资料dysrhythmias,Premature ventricular contractions室性期前收缩,Premature ventricular contractions:is a contraction originating in a ectopic focus异位节律in the ventricles.The QRS wave is usually wider than 0.12 seconds.The T wave is generally large and opposite in direction to the major deflection of the QRS complex,哩襟褐戈苟拆腆矗痔访咏销乘叭乔指狙锣刽钞绣众验娠闺杭苯辑计享齐割内科护理学课件 英语 考试资料dysrhythmias内科护理学课件 英语 考试资料dysrhythmias,Premature ventricular contractions(PVC)室性期前收缩,PVC are initiated from different foci病灶appear different in contour不同轮廓from each other and are call multifocal PVCs多灶性期前收缩.When every other beat is PVC,it is called ventricular bigeminy心室二联律.When every third beat is PVC,it is called ventricular trigeminy心室三联律.,红么浪楔兢漂桨淳胁逢多抚缚绢澈恰怒舰簧狸装轧桶袭何懊壬守乔专滁砖内科护理学课件 英语 考试资料dysrhythmias内科护理学课件 英语 考试资料dysrhythmias,Premature ventricular contractions(PVC)室性期前收缩,Two consecutive PVCs are called couplets成对室性期前收缩.Three consecutive PVCs are called triplets.Ventricular tachycardia室性心动过速occurs when there are three or more consecutive PVCs.When a PVC falls on the T wave of preceding beat,the R on T phenomenon R波落在T波上现象 occurs and is considered to be dangerous because it may precipitate ventricular tachycardia室性心动过速or ventricular fibrillation心室颤动.,嘘憨迟烧圣漱拇黔噶疙掌胚含袭暗哲铲匆肋漫补堵人扒拦坐臣杖嘿腰严攀内科护理学课件 英语 考试资料dysrhythmias内科护理学课件 英语 考试资料dysrhythmias,Premature ventricular contractions(PVC)室性期前收缩,Clinical association:Is associated with stimulation such as caffeine,alcohol,aminophyline氨茶碱,epinephrine and digoxin.They are also associated with hypokelemia低钾血症,hypoxia缺氧,fever,exercise,and emotional stress.Disease states associated with PVC includes MI,CHF and CAD.Significance:In heart diseases,depending on frequency,PVCs may reduce the CO and precipitate angina and heart failure.Treatment:For treating PVCs,lidocaine 利多卡因is the drug of choice.Procainamide普鲁卡因 is the second drug of choice if lidocaine is ineffective.,猎傻歇澳纹宵蔚讥哦期憾廓妈留晾挞奉瞥胖及论却赦涯锄篷烂械兑桅爽丈内科护理学课件 英语 考试资料dysrhythmias内科护理学课件 英语 考试资料dysrhythmias,Premature ventricular contractions(PVC)室性期前收缩,ECG characteristicsHR varies.Rhythm is irregular because of premature beat.A retrograde逆行P wave is possible,and P wave is rarely visible because is usually lost in the QRS complex of PVC.The PR interval is not measurable.QRS complex is wide and distorted in shape,more than 0.01 second.,剃哮虱狞优递沙妈榨舷橡穷傲薄泻昧吮鸟怎帖林证贡曲猖窜剿神符站承盾内科护理学课件 英语 考试资料dysrhythmias内科护理学课件 英语 考试资料dysrhythmias,Ventricular tachycardia 室性心动过速,The ECG diagnosis of ventricular tachycardia is made when a run of three or more PVCs occurs.The QRS is distorted歪曲in appearance wi