Heart, liver, spleen, lung and kidney are important organs of the human body, and the heart ranks first. As we all know, once the heart stops beating, people's lives will be entangled. In the presence of life, the physical and chemical properties and components of human cells remain relatively constant, that is, the internal environment is stable. The heart is like a blood pump, which works day and night, delivering oxygen and nutrients to tissues and organs through arteries, and then delivering human metabolites and carbon dioxide to excretory organs through veins, thus ensuring the metabolism of the body and maintaining the stability of the internal environment. This is the role of the big cycle. Small circulation, also called pulmonary circulation, is a process of gas exchange. Oxygen in the air penetrates into capillaries through alveolar walls, then enters pulmonary veins from capillaries and returns to the heart. Carbon dioxide comes to the capillaries of the lungs, passes through the alveolar wall and is discharged into the alveoli, and then exhaled. After pulmonary circulation, blood becomes blood containing fresh oxygen to supply the needs of the body.
There is also an important blood circulation called coronary circulation, which provides energy for heart beating. The coronary circulation is mainly completed by the coronary artery system. The first pair of aortic branches from the heart are called left coronary artery and right coronary artery. Fresh blood entering the aorta enters the coronary artery first. Coronary artery is also an important blood vessel that provides oxygen and nutrients to the heart itself. The left and right coronary arteries are divided into several branch arteries, which supply different areas around the heart. The anterior descending branch of the left coronary artery is responsible for the blood supply to the anterior wall, apex and interventricular septum of the left and right ventricles of the heart. Most of the left branch nourishes the left ventricle, and a small part nourishes the left atrium and sinoatrial node; The branches of the right coronary artery mainly nourish the right half of the heart. When a branch of coronary artery is diseased, the corresponding myocardium receiving nutrition will be damaged and necrotic, leading to myocardial infarction.
In the long process of biological evolution, the heart has a very strong disease resistance potential. On the myocardial wall of the heart, there are extensive vascular anastomosis, forming a closely related vascular network, also known as collateral circulation. Once a part of the coronary circulation system is disturbed, collateral circulation can replace the function of blocking blood vessels. Because the opening diameters of the left and right coronary arteries are 0.2 ~ 0.75cm and 0.2 ~ 0.70cm, respectively, and the opening diameters of 34% ~ 48% are between 0.4 1 ~ 0.5cm, such thin blood vessels are easy to cause obstruction and get sick.
The coronary circulation supplies the most active organs of the human body. Although the weight of the heart only accounts for about 0.5% of the whole body weight, for a person weighing 70 kg, the total blood flow of the heart is equivalent to 250 ml per minute, accounting for about 5% of the cardiac output. This is because almost all the energy required for heart activity is provided by aerobic metabolism, and the oxygen consumption accounts for 12% of the whole body. When congenital malformation, inflammation, thrombosis, embolism and atherosclerosis occur in coronary artery, it directly affects the blood supply of the heart, resulting in myocardial ischemia and hypoxia, leading to the occurrence of heart disease.
People often say that coronary heart disease is actually a heart disease caused by coronary atherosclerosis.
Arteries are elastic hollow tubes with inner and outer membranes. Under normal circumstances, the intima of artery is fine and smooth. Due to various reasons, the excessive accumulation of lipids, especially cholesterol, in the intima of arteries leads to local intima uplift, white or yellowish, and atherosclerosis, which makes arteries thin and hard. These atheromatous substances narrow the lumen of the artery, make the blood flow blocked, easily form thrombus and even block blood vessels. It is called atherosclerosis.
Because coronary circulation has extensive branches and collateral circulation, coronary artery stenosis caused by atherosclerosis will not appear until it is more serious. When coronary artery stenosis is 50%, there are no conscious symptoms, and when it reaches 75%, there are symptoms such as angina pectoris, and the condition develops rapidly. If the coronary artery is completely blocked due to lumen stenosis or thrombosis, the myocardium supplied by division of labor is ischemic and anoxic, which is the cause of angina pectoris or myocardial infarction. Angina pectoris, myocardial infarction and arrhythmia caused by coronary atherosclerosis are collectively referred to as coronary atherosclerotic heart disease, referred to as coronary heart disease.
The cause of atherosclerosis is still not completely clear, but it has existed since ancient times. The female corpse of the Western Han Dynasty more than 2,000 years ago unearthed in Mawangdui, Changsha, China, has been confirmed to have atherosclerotic plaque and myocardial infarction. Coronary heart disease has a high incidence and mortality in China, which mainly threatens middle-aged and elderly people over 40 years old. In recent years, patients with angina pectoris and myocardial infarction around 30 years old can often be seen. Children's diets in China tend to be more and more westernized, and cream, milk and meat have become children's staple foods. Although this has the function of strengthening physical fitness, at the same time, cholesterol in the blood is also rising, and atherosclerotic plaques are also quietly forming. Therefore, adolescent obesity is the basis of coronary heart disease after middle age and should be paid attention to.
There are more men than women with coronary heart disease, and the number of postmenopausal women with coronary heart disease has increased significantly. This is due to the high level of estrogen in the blood of women in reproductive period, which can delay the formation of arteriosclerosis.
At present, it is considered that smoking, obesity, hypertension and diabetes are the pathogenic factors of coronary heart disease and are closely related to coronary heart disease.
Angina pectoris is a clinical syndrome, which is one of the symptoms caused by acute and temporary myocardial ischemia and hypoxia. It is characterized by paroxysmal chest or left chest compression pain, which is mainly located behind the sternum and can radiate to the left shoulder and left upper limb, causing local pain or discomfort. Angina usually disappears within 5 minutes, and most of them last for several seconds, even 1 ~ 2 minutes. The most common cause of angina pectoris is coronary heart disease.
Coronary atherosclerosis leads to coronary artery stenosis and decreased blood flow, which generally does not happen. Only when blood pressure rises, tachycardia, ventricular hypertrophy and exercise increase myocardial oxygen consumption, resulting in contradiction between supply and rescue and angina pectoris.
The occurrence of angina pectoris in coronary heart disease depends on the location, scope and severity of coronary atherosclerosis. The rich collateral circulation of the heart determines the different situations of angina pectoris in the main branches of coronary artery due to vascular obstruction: some patients have no angina pectoris due to the obstruction of 2 ~ 3 coronary arteries, and some patients have severe angina pectoris due to the obstruction of 1 main coronary artery. No matter what causes the increase of myocardial oxygen consumption and the decrease of coronary blood flow, angina pectoris can be caused.
After physical activity, myocardial oxygen consumption increases. Generally, angina pectoris is easy to occur after cycling, mountain climbing and jogging. Emotional excitement can lead to an increase in heart rate and blood pressure, and induce angina pectoris. It is very common for patients to get sick after watching football matches, the death of relatives and quarreling with others. Eating a lot of animal fat and drinking alcohol at the same time will cause angina pectoris in a few hours. Because drinking and eating can cause coronary artery spasm, narrow lumen and reduce blood flow, and after drinking, blood pressure increases and heart rate accelerates, which increases myocardial oxygen consumption. Cold, hot or seasonal changes and sudden changes in climate may all lead to coronary artery spasm and induce angina pectoris. In addition, angina pectoris can be caused by forced defecation, long-term mental work, smoking and too little sleep.
Clinical manifestations of angina pectoris: Typical angina pectoris often occurs suddenly and lasts for a short time, usually only 1 ~ 5 minutes, rarely exceeding 15 minutes, and some can reach 30 minutes. Location: There are many cases behind the sternum and left anterior chest, ranging from fist to palm, and the position of each attack is relatively fixed. A few patients occurred in the upper abdomen, jaw, neck and back. Typical angina pectoris radiates to the left upper limb, from the left shoulder along the inner side of the left upper arm and left forearm to the little finger and ring finger. Sour swelling, numbness and weakness appear in the above parts. A few patients can radiate to the neck, pharynx, teeth and so on. The nature of pain: squeezing and oppressive pain, often accompanied by the horrible feeling of suffocation and death, forces the patient to stop any activity immediately. Some patients have mild pain. Some are just chest tightness and shortness of breath. Electrocardiogram showed that ST segment could move down, T wave could be straight or inverted, and some patients could be completely normal.
Patients with angina pectoris will be relieved or improved quickly after taking oxygen or nitroglycerin under their tongue.
We should be especially vigilant when the following situations occur:
1? The first angina pectoris shows that the coronary artery disease is quite serious. At this time, the cardiac compensatory function is low, which leads to ECG instability and sudden death.
2? Recurrent or aggravated angina pectoris has stabilized after treatment. Recently, the frequency of pain has increased, the interval has been shortened, the pain has been aggravated, the duration has exceeded 10 minute, and the content of nitroglycerin taken under the tongue has increased or the effect is not good. This is often due to the further development of coronary artery disease and unstable angina pectoris, which is likely to be a precursor of myocardial infarction. You should go to the hospital as soon as possible so as not to delay your illness.
Angina usually occurs during activity and exercise, and it will get better at rest. Some patients only get sick when they are sleeping or lying down, which is called spontaneous angina pectoris. At the onset, the ST segment of ECG is elevated, which resembles the pattern of myocardial infarction, so we should pay attention to the differentiation. This kind of angina pectoris has a good therapeutic effect.
Angina pectoris should be distinguished from other diseases that cause chest pain. Such as cardiac neurosis, intercostal neuritis and cholecystitis.
Treatment of angina pectoris: angina pectoris of coronary heart disease is a chronic disease, which needs long-term treatment. All possible inducing and aggravating factors should be avoided as far as possible to prevent angina pectoris. In addition, angina pectoris is a prelude to myocardial infarction. We must control angina pectoris.
First, general treatment. Arrange life and work reasonably, and don't be overworked and nervous. Diet should be light, mainly vegetables and fruits, eat less and eat more meals, don't eat too much at a time, quit smoking and drinking. Prevent stool exertion. Exercise properly and relax. Bed rest when necessary, oxygen inhalation, unstable angina pectoris. Cardiac monitoring should be carried out and sent to hospital for treatment in time.
Second, medication. The most common method is to take nitroglycerin tablets. Other drugs are beta? Blockers such as propranolol, calcium antagonists such as propranolol and thiazolone. The following focuses on the role and usage of nitroglycerin.
Nitroglycerin has been used in the clinical treatment of angina pectoris for a century. The principle of nitroglycerin is that it can dilate coronary artery and venous blood vessels, reduce the inducement of angina pectoris, reduce myocardial oxygen consumption and increase myocardial blood supply, thus achieving the effect of pain relief. Take nitroglycerin tablets properly, otherwise the expected effect will not be achieved. The following points must be noted.
1? It should be taken sublingually, not swallowed, because sublingual capillaries are abundant, and the drug is quickly absorbed into the blood, and the analgesic effect occurs within 1 ~ 2 minutes. But swallowing and absorption are slow and the effect is poor. 2? Taking nitroglycerin in sitting or semi-lying position has obvious dilating effect on cerebral blood vessels. Flushing and headache occur immediately after taking the medicine, and "orthostatic hypotension" occurs when standing, which is easy to cause syncope. Elderly patients or patients taking medicine for the first time feel dizzy and headache after taking medicine. As long as you lie on your back or have symptomatic treatment, you will soon return to normal without great obstacles. With the extension of medication time, this effect gradually weakened or even disappeared. 3? When choosing the best dosage to start taking nitroglycerin tablets, the dosage should not be too large, otherwise it will have side effects. Generally, one and a half tablets or one tablet (0. 15 ~ 0.30mg) at a time is appropriate. How much dose to take depends on the condition. It is best to find a dose suitable for each patient, which not only achieves curative effect, but also makes the side effects small. If the dose is increased, it will take effect. Taking 3 ~ 5 tablets in a short time means that the condition has changed and you need to see a doctor in time. 4? Nitroglycerin dosage forms can be divided into quick-acting, medium-acting and long-acting dosage forms. When angina pectoris occurs, nitroglycerin tablets and other quick-acting drugs are generally used for first aid. If angina pectoris recurs, medium and long-acting preparations can be taken at the same time to prevent recurrence. The commonly used medium and long-acting drugs are isosorbide dinitrate and long-acting nitroglycerin, and the general efficacy can last for 4 ~ 8 hours. 5? Nitroglycerin tablets combined with other drugs can be taken with propranolol for angina pectoris with faster heart rate; If angina pectoris is accompanied by hypertension, it can be taken with Xintongding. Nitroglycerin can also be combined with verapamil and thiazolone to enhance the curative effect and inhibit the side effects. 6? Nitroglycerin tablets can be used for prevention. For patients who can predict that a certain exertion or activity will produce angina pectoris, nitroglycerin can be used before exertion. For example, angina pectoris is easy to occur after meals and defecation, and nitroglycerin can be taken orally before meals and defecation to prevent the attack. 7? Precautions for use In order to maintain the curative effect of nitroglycerin tablets, the medicine should be placed in a closed colored bottle protected from light, and the expiration date of the medicine should be paid attention to. Tablets approaching the expiration date should be replaced in time. Patients with a history of angina pectoris or the elderly should carry drugs with them and put them in a convenient first aid box.
At present, nitroglycerin has been used as film and oral spray. The patch was externally applied to the left chest, and the drug was absorbed evenly through the skin, and it continued to play an anti-angina role within 24 hours. Oral spray is welcomed by patients because of its small dosage, fast absorption and small side effects. The above two dosage forms are expensive, which is not conducive to popularization and use.
At present, there are many kinds of Chinese and western medicines for treating angina pectoris, some of which have definite curative effects and played a very good therapeutic role.
1? Suxiao Jiuxin Pill is a traditional Chinese medicine preparation. Take 10 ~ 15 pills when angina pectoris attacks, and it will take effect within a few minutes. The medicine can also be taken for a long time, 2 ~ 3 times a day, 5 ~ 10 capsules each time to prevent angina pectoris. Xiao Su Jiuxin Pill is especially suitable for patients with angina pectoris who are not suitable for taking nitroglycerin.
2? Verapamil has a good effect on spontaneous angina pectoris.
3? Other drugs, such as Guanxinsuhe Pills, Compound Danshen Tablets, Xinnaoshutong, etc. It can relax the coronary circulation for a long time, and generally choose 1 ~ 2 according to your own situation.
Common arrhythmia and first aid
Normal heartbeat is regular, and the adult's heart rate is 60 ~ 100 beats per minute, and the interval of each heartbeat is even, and the speed does not exceed 0. 12 seconds. If the heartbeat is too fast or too slow, less than 60 beats per minute or more than 100, the heartbeat interval is irregular, fast and slow, and the heartbeat strength varies, which is called arrhythmia.
There are many reasons for arrhythmia, such as coronary heart disease, rheumatic heart disease, congenital heart disease, hypertensive heart disease, myocarditis, cardiomyopathy and so on. Some drugs such as digitalis and quinidine, excessive smoking, tea and alcohol, temporary mental stress, fatigue and electrolyte imbalance in the body can all cause arrhythmia. Coronary heart disease complicated with arrhythmia is very common and often an important clinical manifestation. When coronary heart disease improves, arrhythmia will be alleviated or disappeared.
There are many kinds of arrhythmia, such as sinus tachycardia, sinus bradycardia and nodal premature beats, which are relatively good in the clinical process and will not cause serious consequences. This article will not discuss them. This article only discusses the serious arrhythmia that needs urgent treatment.
First, ventricular premature beats. Premature beats are also called premature beats, premature beats and premature contractions. Premature beat originated from ectopic pacing point, and compared with other beats in basic rhythm, it is a kind of "premature" or "premature" heart beat in time. The ectopic pacing point that produces premature beats is called ventricular premature beats (referred to as ventricular premature beats). The pacing point of the heart is usually located in the sinoatrial node.
The clinical manifestations of ventricular premature beats include chest tightness, shortness of breath, intermittent heartbeat and palpitation. Patients can tolerate ventricular premature beats less than 5 times per minute, and the symptoms will worsen if they exceed 5 times. But also dizziness, pale face, angina pectoris, hypotension and other symptoms. When ventricular premature beats occur frequently, even in pairs of 20% or 30%, it is called dichotomy and trisection. It reveals the severity of coronary heart disease and may develop into more serious arrhythmia-ventricular tachycardia and ventricular fibrillation. If not corrected in time, it will soon lead to cardiac arrest.
The diagnosis of ventricular premature beats mainly depends on the diagnosis of electrocardiogram besides the above symptoms of chest tightness and shortness of breath. Patients with angina pectoris and myocardial infarction routinely do electrocardiogram and monitor their heart rhythm with ECG monitor, so as to capture the traces of ventricular premature beats at any time and treat them in time.
Treatment of ventricular premature beats: When ventricular premature beats occur in the family, patients with coronary heart disease in the past can be treated as angina pectoris, given oxygen inhalation and sublingual nitroglycerin. After treatment, the heart cavity can shrink or disappear. If it doesn't work, you should go to the hospital in time and be treated with drugs such as propafenone and bradycardia under the guidance of a doctor. Never take it by yourself according to the drug instructions, so as not to cause other serious consequences.
Paroxysmal supraventricular tachycardia. Paroxysmal supraventricular tachycardia is a fast and orderly rhythm, referred to as supraventricular tachycardia, which is more common. It is characterized by sudden attack and sudden stop. During the attack, the patient felt his heart beating fast, as if he were about to jump out, which was very uncomfortable. At the time of attack, the heart rate is 0/50 ~ 250 beats per minute, lasting for several seconds, minutes or hours or days. Sometimes when the doctor comes, the patient has stopped having attacks. Palpitation may be the only manifestation, but if you have a history of coronary heart disease or other heart diseases, you may have dizziness, fatigue, dyspnea, angina pectoris, syncope, and changes in myocardial ischemia on ECG, which will last until 1 ~ 2 weeks after tachycardia stops. Some patients were first diagnosed with coronary artery disease after supraventricular tachycardia. In addition to coronary heart disease, supraventricular tachycardia caused by other reasons, such as hypertensive heart disease, cardiomyopathy, rheumatic heart disease with mitral stenosis, hyperthyroidism and preexcitation syndrome, can be caused. A few young people can have a heart attack without heart disease, but they have a good experience.
Supraventricular tachycardia has the characteristics of recurrent attacks, and the symptoms and ECG characteristics of the first attack are basically similar to those of the later recurrence. Patients with recurrent episodes can judge by themselves that supraventricular tachycardia has occurred, which is beneficial to rescue. However, the diagnosis of supraventricular tachycardia depends on ECG diagnosis, especially in patients with preexcitation syndrome and supraventricular tachycardia. When they have the first attack, they must have an electrocardiogram to make a definite diagnosis, and keep the electrocardiogram, and show it to the doctor when they have another attack or see a doctor, so as to provide a basis for diagnosis and treatment and avoid misdiagnosis.
There are many ways to help patients with supraventricular tachycardia at home. The main purpose is to stop the attack of supraventricular tachycardia as soon as possible and avoid adverse consequences such as heart failure and shock.
Measures to stop supraventricular tachycardia: (1) Ask the patient to hold it after taking a deep breath, and then exhale hard, or hold it after taking a deep breath, and then inhale hard, and repeat. (2) Press the tongue root with a tongue depressor (chopstick head, spoon) to induce nausea and vomiting. (3) press the eyeball. The patient lay on his back, closed his eyes and looked down. The family members press one eyeball with their thumbs and gradually increase the pressure, each time 10 second, and press both eyeballs in turn. The pressing time should not be too long or too strong. When supraventricular tachycardia slows down, stop compression immediately. Glaucoma and high myopia are prohibited. (4) Drug termination must be carried out by a doctor. 0.4 mg of cedilanid, 35 ~ 70 mg of propafenone, or 5 mg of verapamil are commonly used drugs, which should be slowly injected intravenously under ECG monitoring (if there is no such situation, the heartbeat can be auscultated or the pulse can be felt), and once supraventricular tachycardia stops, the injection should be stopped immediately to avoid overdose. Ceylon is forbidden for preexcitation syndrome with supraventricular tachycardia. (5) If family rescue or drug therapy is ineffective and lasts for more than several hours, they should be actively sent to the hospital for further diagnosis and treatment, and electrical cardioversion or esophageal pacing should be performed. (6) In addition to the above rescue, patients with supraventricular tachycardia can be treated as angina pectoris of coronary heart disease, given oxygen inhalation, sublingual nitroglycerin, quick-acting Jiuxin pills, etc. , improve myocardial blood supply and oxygen supply, and sometimes it can relieve or terminate the attack.
Third, atrial fibrillation. Atrial fibrillation is a common arrhythmia in coronary heart disease. In atrial fibrillation, there are 350 ~ 600 irregular impulses in the atrium every minute, and the muscle fibers in various parts of the atrium are uncoordinated and disordered, and the atrium loses effective and consistent contraction, which leads to the influence on ventricular contraction and clinical symptoms.
Atrial fibrillation can be divided into paroxysmal and chronic. Paroxysmal atrial fibrillation can occur suddenly, lasting for several minutes, hours and days, and can be terminated automatically after treatment. Chronic atrial fibrillation does not stop after the attack, and patients with heart disease have become accustomed to it for decades and do not need rescue. What needs first aid in clinic is the aggravation of paroxysmal atrial fibrillation and chronic atrial fibrillation.
1? The main clinical manifestations of atrial fibrillation in patients with rheumatic heart disease are palpitation, shortness of breath, fatigue, dyspnea after fatigue, dizziness, irregular pulse, repeated heart failure and hemoptysis. Atrial fibrillation in coronary heart disease will lead to more insufficient blood supply to coronary arteries due to excessive heart rate and induce angina pectoris. Atrial fibrillation can lead to insufficient blood supply to the brain and cause fainting.
The severity of atrial fibrillation is related to the heart rate, the duration of atrial fibrillation, the degree of heart disease and the state of cardiac function. The heart rate of chronic atrial fibrillation exceeds 100 beats/min, and paroxysmal atrial fibrillation lasts for more than several hours. The heart disease is serious and the heart function is poor. The condition is very critical and needs active rescue.
2? The diagnosis of atrial fibrillation depends on clinical manifestations, including palpitation, dizziness, irregular pulse, heartbeat leakage, arrhythmia, unequal heartbeat, inconsistency between heartbeat and pulse, and pulse beating less than heartbeat. Electrocardiogram as an auxiliary diagnostic means.
3? Rescue measures: (1) Treatment according to the cause. (2) Oxygen inhalation, sublingual administration of nitroglycerin and quick-acting jiuxin pills. (3) Reduce excessive heart rate and use cardiotonic drugs such as digoxin and cedilanid. Generally, patients should be sent to the hospital for emergency treatment as soon as possible. (4) cardioversion of paroxysmal atrial fibrillation, including drug cardioversion and electrical cardioversion, should be performed by doctors under ECG monitoring.
Four. Atrioventricular block. Atrioventricular block (AVB) is caused by coronary heart disease or other heart diseases, which makes the heart conduction system lack of blood supply, blocks the nerve impulses of atria and ventricles, and causes the rhythm of atria and ventricles to beat out of coordination. AVB can be divided into complete and incomplete. Completeness is called third-degree atrioventricular block (ⅲ AVB), and incompleteness is also called first-degree and second-degree atrioventricular block (ⅰ AVB, ⅱ AVB).
The causes of AVB are coronary heart disease, myocardial infarction, rheumatic fever, diphtheria, congenital heart disease, myocarditis, taking some drugs (digitalis, propranolol), hypertension and so on.
1? Clinical manifestations of AVB The classification and classification of AVB mainly depends on the diagnosis of ECG, and the degree (type) can migrate with each other. For example, in acute inferior myocardial infarction, complete atrioventricular block (Ⅲ AVB) can occur when the condition is serious, and incomplete atrioventricular block (Ⅱ AVB or Ⅰ AVB) can be shown in ECG when the condition improves, among which Ⅱ AVB can be divided into Mohs type Ⅰ and Mohs type Ⅱ. Patients with type ⅰ AVB are often asymptomatic and can be seen by routine ECG examination. Patients with type ⅱ and type ⅰ AVB may consciously have heart leakage. Patients with type ⅱ AVB may have dizziness, fatigue, syncope and cardiac insufficiency, and it is easy to develop into type ⅲ AVB. The symptoms of type ⅲ AVB depend on the heart rate. When the heart rate is 40 ~ 60 beats per minute, the patient may only have chest tightness symptoms. When the heart rate is lower than 40 times, symptoms of myocardial ischemia and ischemia will appear, especially after exercise. May appear dizziness, chest tightness, chest pain, syncope, repeated Asperger's syndrome, also known as cardiogenic cerebral hypoxia syndrome. It usually happens when the heart rate is below 20 beats per minute or the heart stops beating. When Asperger's syndrome attacks, the patient suddenly loses his mind, convulses all over his body and foams at the mouth for several seconds or minutes. When the heart rate recovers or increases, the patient recovers quickly. Asperger's syndrome attacks suddenly, often without premonitory symptoms, which makes people unprepared. Repeated attacks of Asperger's syndrome can lead to sudden death. Therefore, grade ⅲ AVB must be actively treated.
2? Rescue measures: (1) When the heart rate is about 40 beats per minute, do not leave the people around you. Once the cardiac arrest caused by Asperger's sign occurs, cardiopulmonary resuscitation should be performed immediately (see Chapter 2 for details). And quickly sent to the hospital or called the family doctor for home visits. (2) Give oxygen, lie on the head side, remove oral secretions, and keep the respiratory tract unobstructed. (3) increase the heart rate, atropine 0.3 mg, once every 4 hours; Ephedrine 25 mg orally, 3 ~ 4 times a day; Breathe 5 ~ 10 mg sublingually, every 4 hours 1 time. Patients with a history of coronary heart disease can take nitroglycerin sublingually or Xiao Su Jiuxin Pills orally. (4) Etiological treatment: Myocarditis should be treated with anti-infection and drug overdose should be stopped to correct acidosis and hyperkalemia. Acute inferior myocardial infarction can be treated with drugs that dilate coronary artery, such as compound Danshen, Guanxinsuhe pill and nitroglycerin. (5) Temporary or permanent artificial pacemakers should be installed for Class III AVB which is ineffective in drug treatment.
Paroxysmal ventricular tachycardia. Paroxysmal ventricular tachycardia (VT) is a serious and rapid arrhythmia, which mostly occurs when the heart disease develops to a serious degree. Different from supraventricular tachycardia, ventricular tachycardia easily leads to serious consequences such as shock, heart failure and cardiac arrest. Sometimes it can't be distinguished at the beginning of the disease or on ECG. Once ventricular tachycardia is suspected or diagnosed, first aid should be given immediately.
The most common cause of ventricular tachycardia is coronary heart disease, others such as cardiomyopathy, hypertensive heart disease, rheumatic heart disease, digitalis poisoning, hypokalemia or hyperkalemia, and heart surgery. Occasionally, the etiology of individual patients is unknown. The factors that induce ventricular tachycardia are exercise, emotional excitement, pregnancy, drinking, drinking coffee and smoking too much.
1? The clinical manifestation of ventricular tachycardia is heart rate 120 ~ 250 beats/min, which can be suddenly terminated. Its severity depends on the degree of heart disease and the duration of tachycardia. Usually manifested as palpitation, chest tightness, dyspnea, angina pectoris, hypotension and syncope. Ventricular tachycardia in acute myocardial infarction indicates that ventricular fibrillation is about to occur.
2? Rescue measures: (1) If the situation is serious, call a critical rescue vehicle to the hospital for emergency treatment, and the patient will stay with him and be sent to the hospital under close supervision. (2) In case of cardiac arrest, cardiopulmonary resuscitation should be performed immediately. (3) Oxygen inhalation, sublingual nitroglycerin and oral quick-acting Jiuxin pills. (4) Lidocaine is the first choice. Intravenous injection of 50 ~ 150 mg is repeated every 5 ~ 10 minutes, and the total amount can reach 400 mg, and then intravenous drip is maintained for 24 ~ 72 hours. Lidocaine must be used in hospitals or by doctors to avoid poisoning and harm to patients. If lidocaine is ineffective, propafenone, bradycardia and other drugs can be used instead. (5) Treatment according to the cause or symptomatic treatment. (6) Cardioversion with synchronous direct current. Generally used after lidocaine and other drugs are ineffective. (7) After the attack stops, choose drugs orally to control the attack and prevent recurrence.