*For medical professionals for reference
The heart rate is fast and slow, what is the syncope of the guy
Writing: Xiao KezhenHeartogenic mixture is one of the three main reasons for syncope.Most of the syncope, and the syncope caused by arrhythmia is nothing more than tachycardia and desolation of heart.familyThe sound of 120 whistle disrupted the already hustle and bustle of the clinic. The emergency personnel promoted a young patient. The clothes on his body were dirty. The emergency staff told Xiao Li.I fainted, and the golfers on the side immediately dialed 120. During the waiting period, a golf friend who had learned to have an first aid knowledge compressed him, and soon the young people recovered their consciousness.
After confirming that the young patients consciousness was clear, Xiao Li immediately conducted a routine test and a heart electrical image (Figure 1).
Figure 1 Consultation ECG
Xiao Li watched the ECG analysis of the atrCExcitement syndrome.Subsequently, the myocardial enzyme and myocal calcium protein i was normal, and the potassium was 4.3mmol/L.Ultrasonic heart dynamic diagram suggests that the left ventricular increase and the reduction of the ejection score of unknown reasons (48%).At this time, Xiao Li felt that the faint of young people may be related to this arrhythmia.Given that the patients life signs have been stable, Xiao Li included the ward after reporting to his superiors after reporting his condition.
Xiao Li returned to Kuri after get off work and participated in pre -operative case discussions. Like Xiao Lis idea, the cause of syncope aimed at the atrium fluttering and pre -excitement syndrome. EssenceIn the sky, the patient received electrical physiological examination, showing the classic atrium fluttering, and successfully melted in the three -pointed gorge (Figure 2).
Figure 2 Figure 2 The three-pointed valve Gorge radio frequency ablation
The HV interval is 68ms under the arrhythmia.The additional stimulation of the programming atrium has led to gradually extending the AH period, but there is no change in the HV interval, pre -excitation, QRS structure and ventricular excitement sequence (Figure 3).Based on these discoveries, it is confirmed that it has the existence of the beam.
In addition, premature atrial stimulation at 310ms causes bypass blockage and does not pass through the front direction of the room. and programmatic electrical stimulus did not observe the rapid forward-to-conduction or induced heart tachycardia, so the beam room is not melted.The patient was discharged soon.
Figure 3 Electricity Check
The story is over here, but youDo you feel a bit wrong? How can the heart rate only be almost slow?Of course, the story continues.
One day a month later, Xiao Li went to work in the emergency department. The ambulance promoted a young patient. Xiao Li recognized him and looked at him with a blossoming face.Ask him how to do it.The patient said that the month after discharge still frequently syncope, which made Xiao Li very puzzled. He made an electrocardiogram for him. In addition to showing that the pre -excitement did not see the tachycardia, the patient was again included in the hospital.
The patients situation also attracted the attention of other doctors in the department. In order to clarify the situation, the patient put on Holter.The patient appeared again that night, but soon woke up, and ECG monitoring showed a three -degree room conduction block.
The result of the turn of the sky came out (Figure 4), which surprised everyone.Holter shows sinus arrhythmia and frequent premature premature beats, accompanied by the left rear beam branches and bypass transmission, and then a complete room transmission block.This shows that all the patients with the patient have conduction abnormalities: the right bundle brace block, the left rear beam support block, and the left front bouquet support block.Rarely, patients are transmitted intermittently by bypass.
Figure 4 Holter and the possible model of the conduction mode (FV, beam chamber bypass; LAF, left front branch; LPF, left back, back rearBranch; RBB, Right Branch)
Experienced director contemplative for a moment, and finally he waved a big hand: It is recommended that patients conduct this test ...
Dear readers and friends, do you know what the directors test is to test?What is the truth about things?References:
[1]. Gong FH, et al. Fasciculoventricular AccessoryPathway Masked Extensive AtrioVentricular Conduction System Disease in a Patient with PRKAG2 Syndrome. 4.
Responsible editor: Silver
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