小结
定义
病史和体格检查
关键诊断因素
- 脉率 <50 bpm
- 年龄＞70 岁
- 使用已知致病药物
- 存在已知的基础病因
- 眩晕/头晕
- 晕厥
- 乏力
- 运动不耐受
- 呼吸短促
- 颈静脉搏动大炮 a 波
- 颈静脉怒张
其他诊断因素
- 颅内压升高
- 异常心音
- 腹部或下肢水肿
- 低血压
- 精神状态改变
- 苍白
- 四肢厥冷
- 体温过低
- 胸痛
- 皮疹
- 甲状腺肿大
危险因素
- 使用已知致病药物
- 年龄＞70 岁
- 近期心肌梗死
- 手术
- 经皮瓣膜置换术
- 甲状腺功能减退
- 电解质紊乱
- 酸中毒
- 感染
- 暴露于毒素
- 体温过低
- 浸润型疾病
- 睡眠障碍性呼吸
- 癫痫
诊断性检查
首要检查
- 12 导联心电图
- 动态心电图监测
- 事件监测器/移动心电遥测
- 运动试验
- 颈动脉窦按摩
- 超声心动图
- 甲状腺功能检测
- 基础代谢检查
- 动脉血气
- 心脏生物标志物
- 血清地高辛水平
- 血清肌酐
需考虑的检查
- 埋藏式心电循环记录器
- 直立倾斜试验
- 伯氏疏螺旋体抗体滴度
- 电生理检查
- 夜间脉搏血氧测定法或整夜多导睡眠图监测
治疗流程
血流动力学不稳定
血流动力学稳定：窦房结功能不全
血流动力学稳定：后天性房室传导阻滞
血流动力学稳定：先天性房室传导阻滞
血流动力学稳定：迷走神经介导的心动过缓
血流动力学稳定：与神经系统障碍有关的心动过缓
撰稿人
作者
Brian Olshansky, MD, FAHA, FACC, FHRS, FESC
Professor Emeritus
University of Iowa
Iowa City
Adjunct Professor
Des Moines University
Electrophysiologist
Covenant Hospital
Waterloo
IA
VA Hospital
Iowa City
IA
CGH Medical Center
Sterling
IL
利益声明
BO declares that he has no competing interests.
Sandeep Saha, MD, MS, FACC, FHRS
Cardiologist and Cardiac Electrophysiologist
Oregon Heart Center
Consultant, Cardiology and Cardiac Electrophysiology
Salem Health Hospitals and Clinics
Salem
OR
利益声明
SS is a consultant for Medtronic and St Jude Medical. He is on the speakers' bureau for Medtronic. None of these activities are relevant to the content of this topic.
Rakesh Gopinathannair, MD, MA, FAHA, FACC, FHRS
Director, Cardiac Electrophysiology Laboratories
Kansas City Heart Rhythm Institute and Research Foundation
EP Medical Director
Research Medical Center, HCA Midwest Health
Overland Park
KS
Clinical Professor of Medicine
University of Missouri-Columbia
Columbia
MO
利益声明
RG is a consultant for St. Jude Medical, Biotrionik, and Boston Scientific. He is on the speakers' bureau for Pfizer Inc. and Zoll Medical. He serves as a physician advisor for HealthTrust PG and AltaThera Pharma, and PaceMate. None of these activities are relevant to the content of this topic.
鸣谢
Professor Brian Olshansky, Dr. Sandeep Saha, and Professor Rakesh Gopinathannair would like to gratefully acknowledge Dr Giselle Statz for her contributions to this version of the topic. They would also like to acknowledge Dr Renee M. Sullivan, Dr Weiwei Li, Dr Alexander Mazur, and Dr Chirag M. Sandesara, previous contributors to this topic.
利益声明
GS, RMS, WL, AM, and CMS declare that they have no competing interests.
同行评议者
Nora Goldschlager, MD
Professor of Clinical Medicine
University of California
Chief
Clinical Cardiology
San Francisco General Hospital
Director
Coronary Care Unit
ECG Laboratory and Pacemaker Clinic
San Francisco
CA
利益声明
NG declares that she has no competing interests.
Paul Heidenreich, MD
Associate Professor of Medicine
Stanford University
Stanford
CA
利益声明
PH declares that he has no competing interests.
Juan M. Sztajzel, MD
Cardiology Center and Medical Polyclinics
University Hospital Geneva
Geneva
Switzerland
利益声明
JMS declares that he has no competing interests.
鉴别诊断
- 室性二联律
- 频发室性期前收缩
- 心房纤颤
更多 鉴别诊断指南
- 2021 年 ESC 关于心脏起搏和心脏再同步治疗指南
- 2020 年 AHA 心肺复苏和心血管急救指南
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