讲稿房颤小讲课.pdf

21/F，心悸一周

30/M，发作性心悸1小时

F/70，阵发心悸4年

M/67，高血压20年，心悸1周

M/72，严重肺气肿，呼吸

AtrialFibrillation

•Definition

–AFisasupraventriculartachyarrhythmiawith

uncoordinatedatrialactivationand

consequentlyineffectiveatrialcontraction

•ECG

–1)irregularR-Rintervals

–2)absenceofdisttrepeatingPwaves

–3)irregularatrialactivity

•fwave350-600bpminV1

Hemodynamicconsequences

•suboptimalventricularratecontrol

•lossofcoordinatedatrialcontraction

•beat-to-beatvariabilityinventricularfilling

•sympatheticactivation

•Ventricularfilling↓↓LVC↓↓CO↓↓

–mitralstenosis,hypertension,hypertrophic

cardiomyopathy(HCM),restrictive

cardiomyopathy

Riskfactors

ReversibleCauses

•bingedrinking,cardiothoracicand

noncardiacsurgery,myocardialinfarction

(MI),pericarditis,myocarditis,

hyperthyroidism,electrocution,ponia,

andpulmonaryembolism

•WPWsyndrome(pre-excitation)，AVNRT，

atrialectopictachycardia

Classification

Historytaking

•CharacterizethepatternofAF

•Determineitscause

•Defineassociatedcardiacand

extracardiacdisease

•Assessthromboembolicrisk

临床表现

•疲乏、心悸、呼吸、低血压、晕厥、

心衰；

•心室率慢时可无症状；心室率>150bpm时可

发生心绞痛、心衰；

•体循环栓塞（脑卒中、外周栓塞）

体格检查

•心音强弱不等

•心率绝对不齐

•脉搏短绌

•心室率较快时难以区分窦性心动过速，阵发性室

上性心动过速，房颤，房扑，AVNRT及AVRT等。

•房颤患者若心律规则

–恢复窦性心律、房速伴传导阻滞、房扑伴传

导阻滞、交界区性心动过速、室性心动过速；心律规

则且慢（30-60次/分）时考虑发生完全性传导阻

滞

Labs

•ECG:diagnosis

•CXR:pulmonarydiseaseandHF

•Echo/TEE:detectunderlyingstructuralheart

diseaseandLA/LAAthrombi,assesscardiac

function,evaluateatrialsize

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