arrhythmia心律失常

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1、Arrhythmia心律失常2010年7月babala1DefinitionArrhythmia（cardiacarrhythmia）aredisordersofimpulseformationand（or）conduction.Thenormalbeatoriginatedfromsinussinusnode.Usually,thefrequencyofwavesrangeswas60to100perminute,whichisregulardayandnight.Theimpulseagitsauriclesandventriclesthroughtheatrioven

2、tricularconductionsystem(AVCS)atthenormalsequence.Foradults,timeisfixed,usually0.12to1.21sec.Furthermore,thetimeofcomductionfromPurkinje‘sfiberstoventricularmusclesisalsofixed，usuallylessthan0.1ms。Impulse冲动，搏动sinusnode窦房结Auricle心房Ventricle心室AVCS房室传导系统Atrioventricular房室的Newwordbook2心律失常的定义心

3、律失常是指心律起源和（或）心搏传导异常。正常心律起源于窦房结，频率范围为60次～100次/分钟，比较规则。窦房结冲动经正常房室传导系统顺序激动心房和心室。对成人而言，传导时间是恒定的，为0.12～1.21秒。同时，冲动经浦肯野纤维到达心室肌的传导时间也是恒定的，通常小于0.10秒。3心脏解剖概图myocardium心肌摘自第16版哈里逊内科学英文版，1311页4ANATOMYOFTHECONDUCTINGSYSTEMUndernormalconditions,thepacemakerfunctionoftheheartresidesinthesinoatrial(SA)no

4、de,whichliesatthejunctionoftherightatriumandsuperiorvenacava.Oncetheimpulseexitsthesinusnode,ittraversestheatriumuntilitreachestheatrioventricular(AV)node.TheSAnodeis1.5cmlongand2to3mmwideandissuppliedbythesinusnodeartery,whicharisesfromeithertherightcoronaryartery(60%)ortheleftcircumflexc

5、oronaryartery(40%).ThebloodsupplyoftheAVnodeisderivedfromtheposteriordescendingcoronaryartery(90%).Newwordbookpacemaker起搏点atrium心房superiorvenacava上腔静脉coronary冠状的posterior后面的derivedfrom得到anatomy解剖学5传导系统的解剖学正常状态下，心脏起搏功能位于窦房结，即右心房与上腔静脉的交界处。冲动一离开窦房结，就经由心房到达房室结。窦房结1.5厘米长，2至3毫米宽，由右冠状动脉窦房结支供养，右冠状

6、动脉窦房结支60%起源于右冠状动脉，40%起源于冠状动脉左旋支。6ANATOMYOFTHECONDUCTINGSYSTEMTheAVnodeliesatthebaseoftheinteratrialseptumjustabovethetricuspidannulusandanteriortothecoronarysinus.TheelectrophysiologicpropertiesoftheAVnoderesultinslowconduction,whichisresponsibleforthenormaldelayinAVconduction。TheSAnode,at

7、rium,andAVnodearesignificantlyinfluencedbyautonomictone.VagalinfluencesdepressautomaticityoftheSAnode,depressconduction,andprolongrefractorinessinthetissuesurroundingtheSAnode。Sympatheticinfluencesexerttheoppositeeffect。NewwordbookVagal迷走神经的tricuspidannulus三尖瓣