最后审阅: 3 十一月 2021
最后更新: 04 六月 2021

小结

定义

病史和体格检查

关键诊断因素

  • 心悸
  • 脉率不规则
  • 危险因素

其他诊断因素

  • 呼吸困难
  • 有症状性低血压
  • 胸痛/胸部紧束感/胸闷
  • 疲劳
  • 焦虑
  • 认知障碍
  • 头晕
  • 多尿
  • 呼吸音异常
  • 额外心音
  • 颈静脉压升高。
  • 卒中征兆
  • 晕厥先兆和晕厥

危险因素

  • 年龄增长
  • 高血压
  • 心力衰竭
  • 糖尿病
  • 阻塞性睡眠呼吸暂停
  • 肥胖
  • 冠状动脉疾病
  • 瓣膜疾病
  • 其他心脏疾病
  • 经常大量饮酒
  • 心胸外科手术
  • 其他房性心律失常
  • 既往卒中/短暂性脑缺血发作
  • 甲状腺功能亢进症
  • 锻炼强度达到运动员水平
  • 慢性阻塞性肺疾病 (COPD)
  • 吸烟

诊断性检查

首要检查

  • 心电图(ECG)
  • 全血细胞计数 (FBC)
  • 凝血功能检查
  • 电解质、尿素和肌酐
  • 甲状腺功能
  • 胸部 X 线检查(CXR)
  • 经胸超声心动图 (TTE)

需考虑的检查

  • 心肌肌钙蛋白
  • 动脉血气分析 (ABG)
  • C 反应蛋白 (CRP)
  • B型脑钠肽(BNP)/氨基端B型脑钠肽前体(NT-pro-BNP)
  • 肝功能检查 (LFT)
  • 红细胞沉降率
  • 经食道超声心动图 (TOE)
  • 住院病人遥测心电图或 24 小时动态心电图
  • 冠状动脉造影(CT 或传统检查)或运动负荷试验
  • 后续钆造影剂增强心脏 MR(cardiac MR, CMR)
  • 头颅 CT
  • 脑部 MRI
  • 计算机断层扫描肺动脉造影 (CTPA)

治疗流程

撰稿人

专家顾问

Resham Baruah, MBBS, BSc, MRCP, PhD

Consultant Cardiologist

Chelsea and Westminster Hospital and the Royal Brompton and Harefield NHS Trust

London

UK

利益声明

RB has received honorarium/speaker fees from Novartis and Boehringer Ingleheim.

Adam D. Hartley, MBBS, BSc, MRCP

Wellcome Trust Clinical Research Fellow

Imperial College London

Specialist Registrar in Cardiology

Imperial College Healthcare NHS Trust

London

UK

利益声明

ADH declares that he has no competing interests.

鸣谢

BMJ Best Practice would like to gratefully acknowledge the previous team of expert contributors, whose work is retained in parts of the content:

Arti N. Shah, MS, MD

Director

Cardiac Electrophysiology

Elmhurst Hospital Center

Elmhurst

Assistant Professor of Medicine

Mount Sinai School of Medicine

New York

NY

ANS is an author of a number of references cited in this topic.

Bharat K. Kantharia MD, FRCP, FAHA, FACC, FESC, FHRS

Cardiovascular and Heart Rhythm Consultant

Attending and Consultant Cardiac Electrophysiologist

Mount Sinai Hospitals

New York Methodist Hospital

New York

NY

West Houston Medical Center

Memorial Hermann Hospital

Houston

TX

BKK is an author of a number of references cited in this topic.

同行评议者

Gregory Lip, MD, FRCP, DFM, FACC, FESC, FEHRA

Price-Evans Professor of Cardiovascular Medicine

University of Liverpool

Senior Investigator

National Institute for Health Research

UK

Distinguished Professor

Faculty of Medicine

Aalborg University

Denmark

Adjunct Professor

Yonsei University

Seoul

South Korea

利益声明

GL is a consultant for Bayer/Janssen, BMS/Pfizer, Medtronic, Boehringer Ingelheim, Novartis, Verseon, and Daiichi-Sankyo. He is a speaker for Bayer, BMS/Pfizer, Medtronic, Boehringer Ingelheim, and Daiichi-Sankyo. No fees are directly received personally. GL is an author of a number of references cited in this topic.

编辑

Tannaz Aliabadi-Oglesby,

Lead Section Editor, BMJ Best Practice

利益声明

TAO declares that she has no competing interests.

Rachel Wheeler,

Lead Section Editor, BMJ Best Practice

利益声明

RW declares that she has no competing interests.

Jo Haynes,

Head of Editorial, BMJ Knowledge Centre

利益声明

JH declares that she has no competing interests.

Julie Costello,

Comorbidities Editor, BMJ Best Practice

利益声明

JC declares that she has no competing interests.

Adam Mitchell,

Drug Editor, BMJ Best Practice

利益声明

AM declares that he has no competing interests.

Shouvik Haldar,

Consultant Cardiologist and Electrophysiologist

Royal Brompton and Harefield Hospitals

London

UK

利益声明

SH was a Section Editor, BMJ Best Practice. SH declares that he has no competing interests.

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