The heart, liver, spleen, lungs and kidneys are important organs of the human body, and the heart is at the top of the list. As we all know, once the heart stops beating, human life ends. In the presence of life, the physical and chemical properties and composition of human cells is to maintain a relatively constant, that is, the stability of the internal environment. The heart is like a blood pump, working day and night, through the arteries to transport the supply of tissues and organs of oxygen and nutrients, and then through the veins to the body's metabolites and carbon dioxide to the excretory organs, thus ensuring the body's metabolism, to maintain the stability of the body's internal environment. This is the role of the major circulation. Minor circulation, also called pulmonary circulation, is a process of gas exchange. Oxygen in the air permeates the capillaries through the alveolar walls and then enters the pulmonary veins from the capillaries to return to the heart. Carbon dioxide comes to the capillaries of the lungs and is discharged through the alveolar walls into the alveoli, and then is exhaled out of the body. Blood through the pulmonary circulation into a fresh oxygen-containing blood and then go to supply the body's needs.
There is another important blood circulation called the coronary circulation, which specializes in supplying energy for the heart to beat. The coronary circulation is accomplished primarily by the coronary artery system. The first pair of branches of the aorta that emanate from the heart are called the left and right coronary arteries. Fresh blood entering the aorta first enters the coronary arteries. The coronary arteries are in turn important vessels that supply the heart itself with oxygen and nutrients. The left and right coronary arteries are divided into a number of branch arteries that surround the heart and supply different areas. The anterior descending branch of the left coronary artery is responsible for the blood supply to the anterior wall of the right and left ventricles of the heart, the apical portion of the heart, and the interventricular septum. When a branch of the coronary arteries becomes diseased, the corresponding myocardium that receives nourishment becomes damaged and necrotic, resulting in myocardial infarction.
In the long process of biological evolution, the heart has a very strong potential to resist disease. Within the myocardial wall of the heart, there is an extensive vascular anastomosis, forming a network of closely related blood vessels, also called collateral circulation. In the event of an obstruction in one part of the coronary circulatory system, the collateral circulation can take over the function of the blocked vessel. Because the left and right coronary arteries open caliber range, respectively, 0.2 to 0.75 cm, 0.2 to 0.70 cm, while 34% to 48% of the open caliber between 0.41 to 0.5 cm, such a thin blood vessels can easily cause obstruction and morbidity.
The coronary circulation is supplied by the body's most active organ. Although the heart weighs only about 0.5% of the body's total body weight, for a person weighing 70 kilograms, the total blood flow to the heart is equivalent to 250 milliliters per minute, or about 5% of the heart's total blood output. This is because the energy required for cardiac activity is supplied almost entirely by aerobic metabolism, with oxygen consumption accounting for 12% of the whole body. When the coronary arteries occur congenital malformation, inflammation, thrombosis, embolism and atherosclerosis and other lesions, directly affecting the blood supply to the heart, resulting in myocardial ischemia, hypoxia, leading to the occurrence of heart disease.
Coronary heart disease, often referred to by the people, is actually heart disease caused by atherosclerosis of the coronary arteries.
Arteries are elastic hollow tubes with inner and outer membranes. Under normal circumstances, the inner lining of the artery is slender and smooth. For a variety of reasons, the arterial lining of lipids, especially cholesterol excessive accumulation, resulting in localized lining bulging, white or yellowish, shaped like porridge, so that the arteries become thin and hard. These atheromatous materials make the arterial lumen narrow, blood flow is not smooth, blood clots are easy to form, and even block the blood vessels. It is called atherosclerosis.
Because of the extensive branching and collateral circulation of the coronary circulation, the narrowing of the coronary artery lumen caused by atherosclerosis does not become symptomatic until it is more severe. When the coronary lumen is narrowed by 50%, there are no conscious symptoms, and angina and other symptoms appear only when the lumen reaches 75%, and then the disease will develop very quickly. If the coronary arteries are completely blocked due to lumen narrowing or thrombosis, the myocardium supplied by the division of labor is deprived of blood and oxygen, which is the cause of angina pectoris or myocardial infarction. Angina pectoris, myocardial infarction, arrhythmia caused by coronary atherosclerosis are collectively known as coronary atherosclerotic heart disease, referred to as coronary heart disease.
The cause of atherosclerosis of the arteries, so far not completely clear, but since ancient times. China's Changsha Mawangdui unearthed more than 2000 years ago, the female corpse of the Western Han Dynasty has confirmed the existence of atherosclerotic plaques and myocardial infarction lesions. Coronary heart disease has a high incidence and high mortality rate in China, mainly threatening middle-aged and elderly people over 40 years old. In recent years, angina pectoris and myocardial infarction patients around 30 years old can also be often seen. Our children's diet tends to be more and more "westernized", cream, milk, meat has become the children's staple food. Although this has led to the role of physical enhancement, but at the same time the blood cholesterol is also rising, atherosclerotic plaque in the quiet formation. Therefore, obesity in adolescence is the basis for coronary heart disease after middle age and should be taken seriously.
Coronary heart disease is more common in men than in women, and there is a significant increase in the number of postmenopausal women with coronary heart disease. This is due to the higher level of estrogen in the blood of women in their reproductive years, and estrogen can delay the formation of atherosclerosis.
It is currently believed that smoking, obesity, hypertension and diabetes are factors in the development of coronary heart disease and have a close relationship with coronary heart disease.
Angina is a clinical syndrome, one of the symptoms caused by acute temporary myocardial ischemia and hypoxia. It is characterized by paroxysmal anterior or left anterior chest pressure pain, mainly located behind the sternum, can radiate to the left shoulder, left upper limb, causing local pain or discomfort. Angina usually disappears within 5 minutes, and most last for a few seconds or even 1 to 2 minutes. The most common cause of angina is coronary artery disease.
Coronary atherosclerosis causes narrowing of the lumen of the coronary arteries and a decrease in blood flow, which normally does not develop. Only when the blood pressure increases, tachycardia, ventricular hypertrophy, exercise and so on to make the myocardium consume more oxygen, resulting in the supply and rescue contradiction, and cause angina pectoris.
The occurrence of angina pectoris in coronary heart disease depends on the location, scope and severity of coronary artery sclerosis lesions. The heart's rich collateral circulation determines the main branches of the coronary artery due to vascular obstruction and the occurrence of angina varies: some patients with coronary artery 2 to 3 branches of obstruction does not develop, while some patients with a trunk of the coronary obstruction caused by severe angina. Whatever the cause of increased myocardial oxygen consumption, coronary blood flow is reduced, can cause angina attack.
After physical activity, myocardial oxygen consumption increases. Generally after cycling, mountain climbing, jogging angina prone to occur. Emotional excitement can cause the heart rate to increase, the blood pressure rises, induced angina. It is common to see the onset of angina after watching a soccer game, the death of a loved one, or an argument with someone. Eating a large amount of animal fat and drinking alcohol at the same time can cause angina after a few hours. Because drinking meals can cause coronary artery spasm, making the narrowed lumen thinner, blood flow is reduced, and drinking alcohol after the blood pressure rises, the heart rate increases and makes the myocardial oxygen consumption increase. Cold, heat or seasonal changes, sudden changes in climate can lead to coronary artery spasm, inducing angina pectoris. In addition, such as forced defecation, long hours of mental labor, smoking, too little sleep, etc. can cause angina attacks.
The clinical manifestations of angina pectoris: typical angina pectoris tends to occur suddenly, short-lived, usually only 1 to 5 minutes, rarely more than 15 minutes, individual up to 30 minutes. Site: the posterior sternum, the left anterior chest is more frequent, the range of fist or palm size, each attack site is relatively fixed. In a few patients, it occurs in the upper abdomen, jaw, neck, and back. Typical angina radiates to the left upper limb, from the left shoulder along the left upper arm and the inner side of the left forearm, all the way to the little finger and ring finger. Sensations of soreness, numbness, and weakness occur in the above areas. A few patients may radiate to the neck, pharynx and teeth. Nature of pain: crushing, constricting pain, often accompanied by a horrible feeling of suffocation and near-death sensation, forcing the patient to stop any activity immediately. Some patients have less severe pain. Some show only chest tightness and shortness of breath. With an electrocardiogram, angina attacks can appear ST segment downward shift, T wave low or inverted phenomenon, some patients can be completely normal.
Angina patients with oxygen or sublingual nitroglycerin quickly reduce or improve the condition.
When the following situations should be particularly alert:
1?First angina pectoris Angina pectoris indicates that the coronary artery disease has been quite serious, at this time the cardiac compensatory function of the heart is low, which results in electrocardiographic instability, susceptible to sudden death.
2?angina recurrent or aggravated angina has been stabilized by treatment, angina pectoris has been stabilized by treatment, the recent increase in the number of pain, shorten the interval, pain aggravation, the duration of more than 10 minutes, the amount of sublingual nitroglycerin increased or the effect is not good. This is often due to the further development of coronary artery disease, angina pectoris is unstable, and is likely to be a precursor symptom of myocardial infarction. It should be treated in the hospital as early as possible to avoid delay.
Angina usually develops at the time of activity and exercise and improves at rest. There is also a part of the patient only in sleep or lying down when the onset, known as spontaneous angina. At the onset of the electrocardiogram ST-segment elevation, similar to myocardial infarction graphics, should pay attention to identify. This kind of angina pectoris patient treatment effect is better.
Angina should be distinguished from other diseases that cause chest pain. Such as cardiac neurosis, intercostal neuritis, cholecystitis and so on.
Treatment of angina pectoris: coronary angina pectoris is a chronic and requires long-term treatment of the disease, should be avoided as far as possible all possible triggering and aggravating factors to prevent angina attacks. In addition, angina is again a prelude to the occurrence of myocardial infarction. Be sure to control angina.
I. General treatment. Proper arrangement of life and work, do not overwork and mental stress. Diet should be light, mainly vegetables and fruits, eat small meals, do not eat too much at a time, should quit smoking and alcohol. Prevent straining the bowels. Appropriate activities to relax the body and mind. If necessary, bed rest, oxygen, suffering from unstable angina, should be cardiac monitoring, timely hospital treatment.
Second, drug treatment. The most commonly used method is to take nitroglycerin tablets. In addition to the other drugs are β?blockers such as cardiac glycosides, calcium antagonists such as cardioplegia, thiazoxazolone. The following highlights the effects and uses of nitroglycerin.
Nitroglycerin has been used in the clinical treatment of angina pectoris for a century, and the principle of nitroglycerin is that it can dilate the coronary arteries and venous blood vessels, alleviate the cause of angina pectoris, reduce the myocardial oxygen consumption, and increase the myocardial blood supply, so as to achieve the effect of pain relief. Taking nitroglycerin tablets, the medication should be taken in a proper way, otherwise it will not achieve the desired effect. The following points must be noted.
1?It is appropriate to take under the tongue, do not swallow because the capillaries under the tongue are very rich, the drug is rapidly absorbed into the blood, 1 ~ 2 minutes that is the effect of pain. The effect of swallowing is poor because of slow absorption.
2. Nitroglycerin has an obvious dilating effect on the cerebral blood vessels, and immediately after taking the drug, there is a flushing, headache, and "upright hypotension" when standing up, which is easy to occur in the wrong syncope. Elderly patients or patients taking the drug for the first time, sitting after taking the drug, there is dizziness and headache, as long as lying down to rest or symptomatic treatment will soon return to normal, no major obstacles. With the prolongation of the time of taking the drug, this effect is gradually reduced to disappear.3?Choose the most ideal amount of medicine When you start to take nitroglycerin tablets, the dose should not be too large, otherwise it will produce side effects. Generally, half or one tablet (0.15-0.30 mg) is better. How much medication to take depends on the condition of the patient, and it is best to find a dose that is suitable for each patient to achieve the therapeutic effect and minimize the side effects. If the amount of medicine can be increased to see the effect of a short period of time to take 3 to 5 tablets, indicating that the condition of the change, the need to consult a doctor in a timely manner.4?Nitroglycerin dosage selection Nitroglycerin can be divided into fast-acting, medium- to long-acting and long-acting dosage form. When angina attacks, first aid is generally used rapid-acting class such as nitroglycerin tablets. If angina is recurrent, medium- and long-acting preparations can be taken at the same time as the attack to prevent another attack. Long-acting drugs commonly used in the category of cardiac pain, long-acting nitroglycerin, the general effect of the drug can last 4 to 8 hours. 5?Nitroglycerin tablets and other drugs angina with fast heart rate, can be taken together with the cardiac angina; angina with high blood pressure, can be taken together with the cardiac pain. Nitroglycerin can also be used in combination with isobarbital and thiazoxazolone to enhance the efficacy of the treatment and to restrain each other's side effects.6?Nitroglycerin tablets can be used prophylactically For the patients who can foresee that a certain exertion or activity will produce angina pectoris, nitroglycerin may be contained before the exertion. For example, if angina is likely to occur after a meal or during a bowel movement, nitroglycerin can be taken orally during meals and before a bowel movement to stop the attack.7?Precautions for use In order to maintain the efficacy of the nitroglycerin tablets, they should be placed in an airtight, light-proof, colored bottle, with attention paid to the expiration date of the drug, and tablets close to the expiry date should be replaced in time. Patients with a history of angina pectoris or the elderly, the drug should be carried with them in a first aid box that is easy to reach.
Currently, nitroglycerin is available as a patch and an oral spray. The patch is applied externally to the left anterior chest, the drug is absorbed evenly through the skin and continues to exert its anti-anginal effect for 24 hours. Oral sprays are popular among patients because of their smaller dosage, faster absorption and fewer side effects. These two dosage forms are more expensive, not conducive to the promotion of the use.
Currently, there are many varieties of Chinese and Western medicines for the treatment of angina pectoris, and some of them are very effective and play a good role in the treatment.
1?Quick-acting heart pill is a Chinese medicine preparation, angina attack take 10 to 15 capsules within a few minutes to see the effect of this drug can also be taken for a long time, 2 to 3 times a day, each time 5 to 10 capsules, to prevent angina attacks. Quick-acting heart pill can be used especially in angina patients who are not suitable for the application of nitroglycerin.
2?Isoboldine is good for spontaneous angina.
3?Other drugs such as coronary heart suhe pill, compound danshen tablets, heart brain shutong and other medicines taken for a long time, can play the role of Shu Tong coronary circulation, generally according to their own conditions to choose one or two of them.
Common arrhythmias and first aid treatment
Normal heartbeat is regular, adult heart rate of 60 to 100 times per minute, the interval between each heartbeat is uniform, fast or slow no more than 0.12 seconds. If the heartbeat is too fast or too slow, less than 60 or more than 100 beats per minute, irregular heartbeat intervals, fast and slow, heartbeat strength is not equal, this is called arrhythmia.
There are many causes of arrhythmia, such as coronary heart disease, rheumatic heart disease, congenital heart disease, hypertensive heart disease, myocarditis, cardiomyopathy, and other kinds of heart disease can cause arrhythmia. Certain drugs such as digitalis, quinidine, etc., tobacco, tea, alcohol excess, momentary mental stress, fatigue, the body electrolyte imbalance can cause arrhythmia. Coronary heart disease combined with arrhythmia is very common, and is often an important clinical manifestation. Coronary heart disease is better, the arrhythmia will reduce or disappear.
There are many types of arrhythmias, such as sinus tachycardia, sinus bradycardia, junctional premature beats, etc. in the clinical process is relatively good, not to cause serious consequences, this article will not discuss. This article only discusses serious arrhythmias that require emergency treatment.
I. Ventricular premature beats. Premature pulsations are also known as premature beats, early beats, and extrasystoles. Premature beats originate from an ectopic pacing site and are cardiac beats that occur "prematurely" or "early" in time compared to other beats in the basic rhythm. If the ectopic pacing site that produces the premature beat is in the ventricle, it is called a premature ventricular beat (or premature ventricular beat for short). The heart's pacing point is normally located in the sinus node.
The clinical manifestations of premature ventricular contractions include chest tightness, shortness of breath, intermittent heartbeats, and palpitations. When ventricular contractions occur less than five times per minute, the patient can still tolerate them, but when they occur more than five times per minute, the symptoms worsen, and there are also symptoms of insufficient blood supply to the heart, such as dizziness, pallor, angina pectoris, and low blood pressure. When ventricular premature appears frequently, even two pairs and three pairs appear, it is called diatonic rhythm and tricyclic rhythm. It reveals the severity of coronary heart disease and is likely to develop into more serious arrhythmias - ventricular tachycardia and ventricular fibrillation. If not corrected in time, it quickly results in cardiac arrest.
The diagnosis of ventricular tachycardia relies heavily on the electrocardiogram in addition to the symptoms of chest tightness and shortness of breath described above. Patients with angina pectoris and myocardial infarction are routinely given electrocardiograms, and cardiac monitors are used to monitor the heart's rhythm and capture any signs of premature ventricular changes so that they can be dealt with in a timely manner.
The treatment of ventricular premature: when ventricular premature patient occurs in the family, if there is a history of coronary artery disease can be treated as angina pectoris, given oxygen and sublingual nitroglycerin. After treatment, ventricular premature can be reduced or disappear. If not effective, we should go to the hospital in time, under the guidance of the doctor to apply cardioplegia, slow heart rhythm and other drugs. Do not take it yourself according to the instructions of the drug, so as not to cause other serious consequences.
Two, paroxysmal supraventricular tachycardia. Paroxysmal supraventricular tachycardia is a paroxysmal fast and neat heart rhythm, referred to as "supraventricular tachycardia", more common. It is characterized by sudden onset and abrupt stop. During an attack, the patient feels that the heart is beating very fast, as if it is going to jump out of his or her chest, which is very uncomfortable. The heart rate is 150 to 250 beats per minute and lasts for several seconds, minutes, hours or days. Sometimes by the time the doctor arrives, the patient has terminated the attack. Panic may be the only manifestation, but if there is a history of coronary or other heart disease, dizziness, weakness, dyspnea, angina, syncope, and changes of myocardial ischemia on electrocardiography may be present and last until 1 to 2 weeks after the tachycardia stops. In some patients, the first diagnosis of coronary morbidity is made after the onset of supraventricular tachycardia. In addition to coronary artery disease, supraventricular tachycardia can be caused by other causes such as hypertensive heart disease, cardiomyopathy, wind heart disease combined with mitral stenosis, hyperthyroidism, and preexcitation syndrome. Individual young people without heart disease can also have an attack, but after a very good.
Supraventricular tachycardia is characterized by recurrent episodes, and the symptoms and electrocardiographic features of the initial episode are basically similar to those of subsequent recurrences. Recurrent episodes can be recognized by the patient as episodes of supraventricular tachycardia, which facilitates ambulance service. However, the diagnosis of supraventricular tachycardia relies on the electrocardiogram, especially in the case of preexcitation syndrome with supraventricular tachycardia, the initial attack must be done at the time of the attack of electrocardiography to clarify the diagnosis, and retain the electrocardiogram, and show it to the doctor during the recurrence of the attack or consultation, to provide the basis for diagnosis and treatment, in order to avoid misdiagnosis.
There are many ways to rescue a patient with supraventricular tachycardia at home, and the main goal is to terminate the episode of supraventricular tachycardia as soon as possible to avoid adverse consequences such as heart failure and shock.
Termination of episodes of supraventricular tachycardia: (1) instruct the patient to take a deep breath and then hold it, and then forcefully do the expiratory action, or deep expiration and then hold it, and then forcefully do the inhalation action, and repeat. (2) Use tongue depressor (chopstick head, spoon) to press the root of the tongue to induce nausea and vomiting movements. (3) Pressure on the eyeballs. The patient lies on his/her back, looks downward with eyes closed, and the family presses one side of the eyeball with the thumb above the eyeball, gradually increasing the pressure for 10 seconds at a time, taking turns to press both sides of the eyeball. The pressure should not be too long and the force should not be too great, and the pressure should be stopped immediately when the supraventricular tachycardia slows down. Glaucoma and high myopia are prohibited. (4) Drugs to terminate the seizure must be carried out by a doctor. Commonly used drugs cediran 0.4 mg, or cardioplegia 35-70 mg, or isobaric 5 mg, all need to be injected slowly intravenously under cardiac monitoring (if not available, you can auscultate the heartbeat or feel the pulse), and once the episodes of supraventricular tachycardia have stopped, stop the injection immediately to avoid overdose of the drug. Cediran is contraindicated in preexcitation syndrome with supraventricular tachycardia. (5) After home rescue or medication is not effective, and the duration is more than a few hours, the patient should be actively sent to the hospital for further consultation and treatment, and undergo electrical resuscitation or esophageal pacing resuscitation. (6) In addition to the above rescue, supraventricular tachycardia patients can be treated according to coronary angina pectoris, given oxygen, sublingual nitroglycerin, fast-acting heart pills, etc., to improve myocardial blood supply and oxygenation, and sometimes can play a role in mitigating or terminating the effect of the attack.
Three, atrial fibrillation. Atrial fibrillation (referred to as atrial fibrillation), is a common arrhythmia of coronary heart disease. Atrial fibrillation, the atria produce irregular impulses 350 to 600 times per minute, the atrial muscle fibers in various parts of the atrium uncoordinated chaotic trembling, the atria lose the effective consistency of the contraction, resulting in the impact on the ventricular contraction, the emergence of clinical symptoms.
Atrial fibrillation is categorized into two types: paroxysmal and chronic. Paroxysmal atrial fibrillation can occur suddenly and last for minutes, hours, or days, and can be terminated with treatment or on its own. Chronic atrial fibrillation does not terminate after an attack, accompanied by cardiac patients for decades, habitual, do not need rescue. The clinical need for first aid is paroxysmal atrial fibrillation and acute exacerbation of chronic atrial fibrillation.
1?The main clinical manifestations of atrial fibrillation palpitations, shortness of breath, fatigue, dyspnea after exertion, dizziness, pulse irregularities, atrial fibrillation patients with wind heart disease repeated heart failure, hemoptysis. Coronary artery disease atrial fibrillation can cause coronary artery more insufficient blood supply due to rapid heart rate, inducing angina pectoris. Atrial fibrillation can cause insufficient cerebral blood supply and fainting.
The severity of atrial fibrillation is related to the rapidity of the heart rate, the duration of atrial fibrillation, the degree of heart disease, the state of heart function. Chronic atrial fibrillation with a heart rate of more than 100 beats per minute, paroxysmal atrial fibrillation lasting for more than a few hours, severe heart disease, poor heart function, the condition is critical and requires active rescue.
2?The diagnosis of atrial fibrillation relies on clinical manifestations, including panic, dizziness, pulse irregularity, missed beats, arrhythmia, heartbeat strength is not equal, the heartbeat and the pulse of the Biao movement is inconsistent, the pulse beats less than the heartbeat and so on, the electrocardiogram as a supplementary diagnostic means.
3?Ambulance measures: (1) for the cause of treatment. (2) Oxygen intake, sublingual nitroglycerin, taking fast-acting heart pill. (3) Reduce the rapid heart rate, with cardiac drugs such as digoxin, cediran. Generally, the patient should be sent to the hospital for emergency treatment as soon as possible. (4) Resuscitation of paroxysmal atrial fibrillation, divided into drug resuscitation and electrical resuscitation, both need to be carried out by a doctor under cardiac monitoring.
Four, atrioventricular block. Atrioventricular block (AVB for short), is due to coronary heart disease or other heart disease so that the blood supply of the cardiac conduction system is insufficient, so that the atrium to the ventricle of the nerve impulses are blocked, caused by the atrium and ventricle of the rhythm of each jump, can not be coordinated.AVB is divided into complete and incomplete, the complete is called the third degree of atrioventricular block (Ⅲ ° AVB), incomplete is also known as the first and second degree of atrioventricular block (Ⅰ ° AVB), and incomplete is called the first and the second degree of AVB. (I°AVB, II°AVB).
The causes of AVB include coronary heart disease myocardial infarction, rheumatic fever, diphtheria, congenital heart disease, myocarditis, use of certain medications (digitalis, cardiac glycosides), hypertension, and so on.
1?Clinical manifestations of AVB The degree and type of AVB mainly rely on the diagnosis of the electrocardiogram, and each degree (type) can be shifted to each other. For example, in acute inferior wall myocardial infarction, complete atrioventricular block (Ⅲ°AVB) can occur when the condition is serious, when the condition improves, the electrocardiogram shows incomplete atrioventricular block (Ⅱ °AVB or Ⅰ °AVB), of which Ⅱ °AVB can be divided into Mo's Ⅰ type, Mo's Ⅱ type. Patients with Ⅰ° AVB are often asymptomatic and are found during routine examination of the electrocardiogram. Patients with II° type I AVB may be self-conscious of beat-to-beat deregulation. Patients with II° II AVB may have dizziness, fatigue, syncope, and cardiac insufficiency, which tends to progress to III° AVB.Symptoms of III° AVB depend on the heart rate. With a heart rate of 40 to 60 beats per minute, the patient may have only symptoms of chest tightness, and with a heart rate of 40 beats or less, symptoms of myocardial ischemia and ischemia occur, which are more pronounced after activity. There can be dizziness, chest tightness, chest pain and syncope, and recurrent Asperger's syndrome, also known as cardiogenic cerebral hypoxia syndrome. It usually occurs when the heart rate is less than 20 beats per minute or when the heart stops. An attack of Asperger's syndrome is characterized by sudden confusion, convulsions, and foaming at the mouth that lasts for seconds or minutes, and the patient recovers quickly when the heart rate resumes or speeds up. An Asperger's attack is sudden and often occurs without warning, catching people off guard. Repeated episodes of Aspergers can lead to sudden death. Therefore, III° AVB must be treated aggressively.
2?Ambulance measures: (1) has occurred in the Aschers' sign of Ⅲ ° AVB patient heart rate of about 40 times per minute, the side can not be left, once the Aschers' sign caused by cardiac arrest, should immediately carry out cardiopulmonary resuscitation (see Chapter II). And quickly send to the hospital or call the family doctor out for treatment. (2) Give oxygen, position the head laterally, remove oral secretions, and keep the airway open. (3) Increase the heart rate with atropine 0.3 mg orally once every 4 hours; ephedrine 25 mg orally 3 to 4 times a day; and wheezing 5 to 10 mg sublingually every 4 hours. Patients with a history of coronary artery disease can take sublingual nitroglycerin or oral fast-acting heart pills. (4) Etiological treatment, myocarditis given anti-infective treatment, drug overdose is discontinued, correct acidosis and hyperkalemia, acute lower wall myocardial infarction can be given to dilate the coronary artery drugs such as compound salvia, coronary heart Suhuo pill, nitroglycerin and so on. (5) Ⅲ ° AVB by drug treatment is invalid need to install temporary or permanent artificial pacemaker.
V. Paroxysmal ventricular tachycardia. Paroxysmal ventricular tachycardia (referred to as ventricular tachycardia), is a serious and rapid arrhythmia, ventricular tachycardia mostly occurs when the heart disease develops to a severe degree. Unlike supraventricular tachycardia, episodes of ventricular tachycardia can easily cause shock, heart failure, cardiac arrest, and other serious consequences. And sometimes it is impossible to distinguish it in the early stages of development or on an ECG. Once ventricular tachycardia is suspected or has been diagnosed, it should be immediately put into emergency care.
The most common cause of ventricular tachycardia is coronary artery disease, and other causes such as cardiomyopathy, hypertensive heart disease, rheumatic heart disease, digitalis intoxication, low or high blood potassium, and cardiac surgery can be caused. Occasionally, the cause is unknown in individual patients. Factors that trigger ventricular tachycardia include exercise, emotional excitement, pregnancy, drinking alcohol, drinking coffee and smoking too much.
1?Ventricular tachycardia is characterized by a heart rate of 120 to 250 beats per minute, which can be terminated suddenly. Its severity depends on the degree of heart disease and the duration of tachycardia. It usually manifests palpitations, chest tightness, dyspnea, angina, hypotension, and syncope. When ventricular tachycardia occurs in acute myocardial infarction, it signals that ventricular fibrillation is imminent.
2?Ambulance measures: (1) the situation is serious, call the critical care vehicle to come to the emergency, the patient's side is not away from people, under close supervision to the hospital. (2) Once the cardiac arrest, immediate cardiopulmonary resuscitation. (3) Administer oxygen, sublingual nitroglycerin, and oral rapid-acting heart pills. (4) Lidocaine is the drug of choice, 50 to 100 mg intravenously, repeated at 5 to 10 minute intervals of 50 mg for a total of up to 400 mg, and then maintained by intravenous drip for 24 to 72 hours. Lidocaine must be used in the hospital or applied by a physician to avoid toxicity, which can be detrimental to the patient. Ineffective lidocaine can be changed to cardioplegia, slow heart rhythm and other drugs. (5) Treatment for the cause or symptomatic treatment. (6) Resuscitation with synchronized direct current. Generally, it is applied after the failure of lidocaine and other drugs. (7) After the seizure is aborted, the drugs used to control the seizure are taken orally to prevent recurrence.
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