小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 年龄＞50～60 岁
- 晕厥
- 心率＜40 次/分
- 先兆晕厥
其他诊断因素
- 男性
- 疲劳
- 呼吸困难
- 胸痛、心悸和恶心或呕吐
- 血压升高（血压降低相对少见）
- 颈静脉巨大 A 波（大炮波）
- 缺氧
- 房室传导阻滞家族史
- Lyme 病的特征
危险因素
- 在传导系统中与年龄有关的退化性改变
- 迷走神经张力升高
- 房室结传导阻滞剂
- 慢性稳定型冠状动脉疾病
- 急性冠脉综合征
- 近期心脏手术、介入术或消融术
- 充血性心力衰竭 (CHF)
- 高血压
- 心肌病
- 左心室肥大
- 酸碱失衡或电解质紊乱
- 神经肌肉类疾病
- 结节病
- 巨细胞心肌炎
- 心脏结核病
- Lyme病
- 感染性心内膜炎
- 低氧血症
- 心脏钝性损伤
- 某些本土药物
诊断性检查
首要检查
- 12 导联心电图
- 血清肌钙蛋白
- 血钾
- 血清钙
- 血清 pH
- 血清洋地黄水平
需考虑的检查
- 24 小时动态心电图或者事件记录器监测
- 胸部 X 线检查
- 经胸超声心动图
- Lyme 病的血清学检测
- 直立倾斜试验
- 电生理学检查
- 心脏负荷试验
- 冠状动脉造影
- 血清 CK-MB
治疗流程
一度房室传导阻滞或者二度 I 型房室传导阻滞
二度 II 型房室传导阻滞或者三度房室传导阻滞
撰稿人
作者
Sanjiv Petkar, MD, FRCP
Consultant Cardiologist/Electrophysiologist
Royal Wolverhampton NHS Trust
Heart and Lung Centre
New Cross Hospital
Wolverhampton
UK
利益声明
SP has received speaker's honoraria from Bayer, Bristol-Myers Squibb, MSD, and Pfizer. SP has received hospitality and/or accommodation from Bayer, Medtronic, St Jude, and Boston Scientific for attending conferences or meetings.
Dibbendhu Khanra, MD, DM Cardiology
International Clinical Fellow in Electrophysiology and Devices
Royal Wolverhampton NHS Trust
Heart and Lung Centre
New Cross Hospital
Wolverhampton
UK
利益声明
DK declares that he has no competing interests.
Gaurav Panchal, MBBS, MRCP
Specialist Registrar in Cardiology/Electrophysiology
Royal Wolverhampton NHS Trust
Heart and Lung Centre
New Cross Hospital
Wolverhampton
UK
利益声明
GP declares that he has no competing interests.
鸣谢
Dr Petkar, Dr Khanra, and Dr Panchal would like to gratefully acknowledge Dr Pathiraja, Dr Aziz, Dr Susan S. Kim, Dr John F. Beshai, and Dr Stephen L. Archer, previous contributors to this topic. JP, AA, SSK, JFB, and SLA declare that they have no competing interests.
同行评议者
Bradley P. Knight, MD
Professor of Medicine
Section of Cardiology
Director
Cardiac Electrophysiology
University of Chicago Medical Center
Chicago
IL
利益声明
BPK declares that he has no competing interests.
Martin C. Burke, DO
Associate Professor of Medicine
Section of Cardiology
Cardiac Electrophysiology
University of Chicago Medical Center
Chicago
IL
利益声明
MCB declares that he has no competing interests.
Nick Gall, MSc, MD, FRCP
Consultant Cardiologist
King’s College Hospital
London
UK
利益声明
NG declares that he has no competing interests.
Thomas A. Dewland, MD
Associate Professor of Medicine
University of California
San Francisco
CA
利益声明
TAD declares that he has no competing interests.
鉴别诊断
- 交界性心律
- 室上性心动过速(SVT)
- 心房纤颤动或多源性房性心动过速（MAT）
更多 鉴别诊断指南
- 2022 年 AHA/ACC/HFSA 心力衰竭管理指南
- 2021 年 ESC 关于心脏起搏和心脏再同步治疗指南
更多 指南患者教育信息
何为心房颤动？
心房颤动：如何有效治疗？
更多 患者教育信息
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