口腔会有湿疣吗:疾病大全:心律失常

来源:百度文库 编辑:学校大全网 时间:2022/08/17 18:58:51

By Mayo Clinic staff  (原文地址

Heart rhythm problems (heart arrhythmias) occur when the electrical impulses in your heart that coordinate your heartbeats don't work properly, causing your heart to beat too fast, too slow or irregularly.
Heart arrhythmias (uh-RITH-me-uhs) are often harmless. Most people have occasional, irregular heartbeats that may feel like a fluttering or racing heart. However, some heart arrhythmias may cause bothersome — sometimes even life-threatening — signs and symptoms.
Heart arrhythmia treatment can often control or eliminate irregular heartbeats. In addition, because troublesome heart arrhythmias are often made worse — or are even caused — by a weak or damaged heart, you may be able to reduce your arrhythmia risk by adopting a heart-healthy lifestyle.


定义与概述

   心律失常(也称心律不齐)是指心脏电冲动的起源或传导的异常,从而导致心跳的异常——过快、过慢、或是不规则。

   心律失常经常是无害的。大多数人都有过这种经历:心脏好像要跳出嗓子眼儿。然而,有一些心律失常却很讨厌,甚至是致命的。

   一般而言,通过恰当的治疗可以控制乃至根治心律失常。另一方面,因为心脏功能的下降会加重心律失常(有些时候,前者甚至是后者的直接原因),患者也需要一种对心脏有益的生活方式。

Symptoms
 Arrhythmias may not cause any signs or symptoms. In fact, your doctor might find you have an arrhythmia before you do, during a routine examination.
 Some people do have noticeable arrhythmia symptoms, which may include:
  



症状&体征    心律失常不是很容易发现的,很可能是在做例行体检时医生告诉你的。

   一些人有明显的症状,比如:
A fluttering in your chest
 A racing heartbeat (tachycardia)
 A slow heartbeat (bradycardia)
 Chest pain
 Shortness of breath
 Lightheadedness
 Dizziness
 Fainting (syncope) or near fainting
 Noticeable signs and symptoms don't always indicate a serious problem. Some people who feel arrhythmias don't have a serious problem, while others who have life-threatening arrhythmias have no symptoms at all.
   ● 感觉胸口里面有东西在扑动。
   ● 感觉心跳得很快或是很慢。
   ● 胸疼或胸闷,气短。
   ● 头晕眼花,甚至近乎晕厥。

    症状与体征明显并不意味疾病严重。一些心律失常严重的患者往往没有任何症状,而另一些较轻的患者却可能表现得很严重。 
When to see a doctor
 Arrhythmias may cause you to feel premature heartbeats, or you may feel that your heart is racing or beating too slowly. Other signs and symptoms may be related to reduced blood output from your heart. These include shortness of breath or wheezing, weakness, dizziness, lightheadedness, fainting or near fainting, and chest pain or discomfort. Seek urgent medical care if you suddenly or frequently experience any of these signs and symptoms at a time when you wouldn't expect to feel them.

§ 何时看医生?

     心律失常会让你觉得心跳不规则(比如一段时间的规律跳动后突然出现一个提前的跳动),或是心跳过快、过慢。心跳的异常会影响心脏的泵血功能,进而产生这些症状:气短或喘息(大喘气),虚弱无力,头晕眼花几近晕倒,胸口不适(胸闷或胸疼)。当你莫名其妙出现以上症状时,请速就医。
Ventricular fibrillation (VF) is one type of arrhythmia that is deadly. It occurs when the heart beats with rapid, erratic electrical impulses. This causes pumping chambers in your heart (the ventricles) to quiver uselessly, instead of pumping blood. Without an effective heartbeat, blood pressure plummets, cutting off blood supply to your vital organs. A person with ventricular fibrillation will collapse within seconds and soon won't be breathing or have a pulse. If this occurs, follow these steps:
   

   室颤是一种致命的心律失常。此时心跳快、微弱、而不协调。心室快速而无用地乱颤,无法有效地泵血,从而导致血压快速下降无法给各器官提供充足的血液。事实上,一个人发生室颤几秒钟后就会停止心跳与呼吸。如果你撞见了,请立即:

Call 911 or the emergency number in your area.
 If you or someone nearby knows cardiopulmonary resuscitation (CPR), begin providing it if it's needed. CPR can help maintain blood flow to the organs until an electrical shock (defibrillation) can be given.
 Portable defibrillators, which can deliver an electric shock that may restart heartbeats, are available in an increasing number of places, such as in airplanes, police cars and shopping malls. They can even be purchased for your home. Portable defibrillators come with built-in instructions for their use. They're programmed to allow a shock only when appropriate.
   1、打120。
   2、心肺复苏。在除颤实施之前,它可以帮助维持重要器官的供血。(当然,一旦除颤就位,以除颤优先)
   3、除颤。如果身边有除颤器,及早正确地使用。
Many things can lead to, or cause, an arrhythmia, including:



病因学    心律失常可能的原因有:

Scarring of heart tissue (such as from a heart attack)
 Changes to your heart's structure, such as from cardiomyopathy
 Blocked arteries in your heart (coronary artery disease)
 High blood pressure
 Diabetes
 Overactive thyroid gland (hyperthyroidism)
 Smoking
 Drinking too much alcohol or caffeine
 Drug abuse
 Stress
 Medications
 Dietary supplements and herbal treatments
 Electrical shock
    ● 心肌瘢痕,或是心脏结构的改变(往往是由之前的心脏病引起的,比如心肌炎,心梗)。
    ● 冠状动脉疾病(常说的冠心病)。
    ● 高血压、高血糖、甲亢。
    ● 烟、酒、咖啡因摄入过量。
    ● 嗑药。或是常规用药的副作用。
    ● 保健品、中草药等使用不当。
    ● 精神压力过大。
    ● 被电击(电休克)。
What's a normal heartbeat?


§ 正常心跳是什么样的?

When your heart beats, the electrical impulses that cause it to contract follow a precise pathway through your heart. Any interruption in these impulses can cause an arrhythmia.
 Your heart is divided into four hollow chambers. The chambers on each half of your heart form two adjoining pumps, with an upper chamber (atrium) and a lower chamber (ventricle).
 During a heartbeat, the atria contract and fill the relaxed ventricles with blood. This contraction starts when the sinus node — a small group of cells in your right atrium — sends an electrical impulse causing your right and left atria to contract.
 The impulse then travels to the center of your heart, to the atrioventricular node that lies on the pathway between your atria and your ventricles. From here, the impulse exits the atrioventricular node and travels through your ventricles, causing them to contract and pump blood throughout your body.
 In a healthy heart, this process usually goes smoothly, resulting in a normal resting heart rate of 60 to 100 beats a minute. Athletes at rest commonly have a heart rate less than 60 beats a minute because their hearts are so efficient.
   

   心脏右上角的窦房结会规律性地发出电脉冲,电脉冲通过一系列错综复杂的通路传导至心脏各处,由此产生规律性的收缩。这其中任一处出现问题都会导致心率出现异常。

   心跳时,窦房结的细胞首先兴奋并发出电脉冲,传导至心房肌使其收缩,将血液挤进还没有开始收缩的心室。 

   之后,电脉冲传导至房室结——它位于心脏的正中——并继续向下传导至心室肌,心室肌收缩将血液泵往全身(左心室的血泵至体循环给器官供血,右心室的血泵至肺部进行气体交换)。

   正常人的心跳很平稳,每秒60-100次。运动员的心率可能更低,那是因为他们的心脏比一般人更强健更有效率。



Types of arrhythmias
 Doctors classify arrhythmias not only by where they originate (atria or ventricles) but also by the speed of heart rate they cause:

心率失常的分类    根据病变部位和心跳快慢,心率失常分为:

 Tachycardia (tak-ih-KAHR-de-uh). This refers to a fast heartbeat — a resting heart rate greater than 100 beats a minute.
 Bradycardia (brad-e-KAHR-de-uh). This refers to a slow heartbeat — a resting heart rate less than 60 beats a minute.
 Not all tachycardias or bradycardias mean you have heart disease. For example, during exercise it's normal to develop tachycardia as the heart speeds up to provide your tissues with more oxygen-rich blood.
     心动过速:    静息状态下超过100次/分。 

     心动过缓:    静息状态下少于60次/分。

   并非所有心动过速或过缓都意味着心脏病。比如运动时心跳会很快,这样会更好地为组织供血。

  
Tachycardias in the atria
 Tachycardias originating in the atria include:

心房的心动过速    包括

 Atrial fibrillation. This fast and chaotic beating of the atrial chambers is a common arrhythmia. It mainly affects older people. Your risk of developing atrial fibrillation increases past age 60, mostly due to wear and tear on your heart, especially if you've had high blood pressure or other heart problems. During atrial fibrillation, the electrical signal that causes your heart to beat becomes uncoordinated. The atria beat so rapidly — as fast as 350 to 600 beats a minute — that instead of producing a single, forceful contraction, they quiver (fibrillate). One type of atrial fibrillation — paroxysmal fibrillation — can last a few minutes to an hour or more before returning to a regular heart rhythm. It can also be an ongoing problem. Atrial fibrillation can be dangerous, for over time it can cause more-serious conditions, such as stroke.
房颤(心房颤动)  这是一种常见的心律失常,表现为心房快速而混乱地跳动,且主要发生在老年人。随着年龄的增长(>60岁),心脏经年累月的劳损会增加房颤的风险,尤其是在高血压和其他心脏病的人群中。房颤时,心脏的电脉冲变得不协调。心房以350-600次/分的高速颤动,而不能产生有效的收缩(就像做广播体操时偷懒)。阵发性房颤(PAF)常持续几分钟至一小时不等,有时也会持续很长时间。房颤比较危险,因为时间长了它可能导致很严重的并发症,比如中风。
Atrial flutter. Atrial flutter is similar to atrial fibrillation. Both can occur, coming and going in an alternating fashion. The heartbeats in atrial flutter are more-organized and more-rhythmic electrical impulses than in atrial fibrillation. Atrial flutter can be life-threatening.


房扑(心房扑动)  房扑与房颤类似,并可以与之互相转化。房扑时,心脏的电生理活动要比房颤时更有规则、更有节奏一些。但急性房扑也可以是致命的。

   
Supraventricular tachycardia (SVT). SVT is a broad term that includes many forms of arrhythmia originating above the ventricles (supraventricular). SVTs usually cause a burst of rapid heartbeats that begins and ends suddenly and can last from seconds to hours. These bursts often start when the electrical impulse from a heartbeat begins to circle repeatedly through an extra pathway. SVT may cause your heart to beat 160 to 200 times a minute.
 SVT is often caused by an underlying heart condition. Although SVT is generally not life-threatening in an otherwise normal heart, symptoms from the racing heart may feel quite uncomfortable. These arrhythmias are common in young people.
 Wolff-Parkinson-White syndrome. One cause of SVT is known as Wolff-Parkinson-White syndrome. This arrhythmia is caused by an extra electrical pathway between the atria and the ventricles. This pathway may allow electrical current to pass between the atria and the ventricles without passing through the atrioventricular node, leading to short circuits and rapid heartbeats.
   

室上速(室上性心动过速)  室上速的范围很广,它包涵很多源于心室以上的组织的心律失常。室上速通常的症状是:突然感到剧烈的心跳(如果你能数得清——我赌你不能——此时你的心率约在160-200次/分),可以持续几秒钟至个把小时。通常这是因为,电脉冲在异常的环路中进行传导(跑偏了)。


   室上速常由潜在的心脏疾患引起。一颗健康心脏产生的室上速并不危及生命,但它会让人感觉很不爽。室上速在青年人中比较常见。

预激综合症(W-P-W症候群)  这是一种引起室上速的原因,特征为心房与心室间出现额外的电传导通路。这个额外的通路会使电流不再从正常的通路——经过房室结——流过(短路了),从而产生快速的心跳。
Tachycardias in the ventricles
 Tachycardias occurring in the ventricles include:

  

心室的心动过速    包括

Ventricular tachycardia (VT). This fast, regular beating of the heart is caused by abnormal electrical impulses that start in the ventricles. Often these are due to a problem with the electrical impulse traveling around a scar from a previous heart attack. VT can cause the ventricles to contract more than 200 beats a minute.
 Most VT occurs in people with some form of heart-related problem, such as scars or damage within the ventricle muscle from coronary artery disease or a heart attack. Sometimes VT can last for 30 seconds or less (unsustained), and it might not cause any symptoms, although it causes inefficient heartbeats. Still, an unsustained VT may put you at risk of more-serious ventricular arrhythmias, such as longer lasting (sustained) VT. An episode of sustained VT is a medical emergency. Without prompt medical treatment, sustained ventricular tachycardia often worsens into ventricular fibrillation.
室速(室性心动过速)  通常情况下心室肌在接受到从窦房结传来的电信号后开始收缩。室速时,心室肌则在接受到其它组织产生的(比如,先前心脏病留下的心肌瘢痕)电信号后开始收缩。室速时的心率通常大于200次/分。

      绝大多数室速患者有相关的心脏疾患,比如由冠心病、心梗、心肌病等引起的心肌损伤或瘢痕。有时室速的持续时间不会超过半分钟(非持续性室速),也不会有任何症状,虽说这期间心脏会有一些无效的跳动。然而,非持续性室速有可能发展为更加严重的持续性室速,这时则需要紧急处理。如果处理不当,持续性室速常可发展为室颤。
Ventricular fibrillation. In ventricular fibrillation, rapid, chaotic electrical impulses cause your ventricles to quiver uselessly instead of pumping blood. Without an effective heartbeat, your blood pressure plummets, instantly cutting off blood supply to your vital organs — including your brain. Most people lose consciousness within seconds and require immediate medical assistance, including cardiopulmonary resuscitation (CPR). Your chances of survival may be better if CPR is delivered until your heart can be shocked back into a normal rhythm with a device called a defibrillator. Without CPR or defibrillation, death results in minutes. Most cases of ventricular fibrillation are linked to some form of heart disease. Ventricular fibrillation is frequently triggered by a heart attack.

室颤(心室颤动)  像前面说的的那样,此时心室快速而混乱地颤动,完全失去了泵血的能力。血压急剧下降,无法给组织器官提供血液——甚至是你的大脑。因此一旦发生室颤病人常在几秒钟内失去知觉。此时需要做的就是心肺复苏(心脏按压+人工呼吸,前者优先于后者)和电除颤。在实施心肺复苏之前,通过除颤器将病人心率电击至正常会提高存活率。如果不具备上述两个条件,病人很可能会在几分钟内死亡。室颤通常是由心脏疾病引起的,比如心梗。

Long QT syndrome. Long QT syndrome (LQTS) is a heart rhythm disorder that carries an increased risk of fast, chaotic heartbeats. The rapid heartbeats, caused by changes in the part of your heart that causes it to beat, may lead to fainting, which can be life-threatening. In some cases, your heart's rhythm may be so erratic that it can cause sudden death.
 You can be born with a genetic mutation that puts you at risk of long QT syndrome. In addition, more than 50 medications, many of them common, may cause long QT syndrome. Some medical conditions, such as congenital heart defects, also may cause long QT syndrome.
长Q-T间期综合征(也有人叫它尖端扭转型心动过速)  这种情况下心跳快而混乱,心电图上表现为Q-T间期延长。它是由心脏电传导通路上的某些问题引起的,但其确切的机制至今未明。类似室颤,此时病人可能会昏迷,并有生命危险。有时,长Q-T间期综合征甚至可以引起猝死。

   长Q-T间期综合征的病因包括: 基因突变;一些药物的副作用;某些疾病(比如先天性心脏病)。

Bradycardia — a slow heartbeat
Although a heart rate below 60 beats a minute while at rest is considered bradycardia, a low resting heart rate doesn't always signal a problem. If you're physically fit, you may have an efficient heart capable of pumping an adequate supply of blood with fewer than 60 beats a minute at rest. However, if you have a slow heart rate and your heart isn't pumping enough blood, you may have one of several bradycardias, including:


心动过缓

    虽说一个人的静息心率小于60次/分时可以考虑心率过缓,但这并不意味着他/她肯定有问题。如果你很强健,那么很可能心脏用不着跳到60次/分就可以完成它的泵血任务了。然而,当心率慢并且心脏泵血不足时,就可能出现心动过缓,包括:

Sick sinus. If your sinus node, which is responsible for setting the pace of your heart, isn't sending impulses properly, your heart rate may be too slow, or it may speed up and slow down intermittently. Sick sinus can also be caused by scarring near the sinus node that's slowing, disrupting or blocking the travel of impulses.

病窦综合征(SSS)  顾名思义,此时窦房结本身——也就是心脏电传导通路的源头——出现了问题,从而使心率变得过慢,或是忽快忽慢。病窦综合征也可能由窦房结附近的瘢痕组织引起,后者会减慢、干扰、或是阻断电冲动的传导。

Conduction block. A block of your heart's electrical pathways can occur in or near the atrioventricular node, which lies on the pathway between your atria and your ventricles. A block can also occur along other pathways to each ventricle. Depending on the location and type of block, the impulses between the upper and lower halves of your heart may be slowed or blocked. If the signal is completely blocked, certain cells in the AV node or ventricles can make a steady, although usually slower, heartbeat. Some blocks may cause no signs or symptoms, and others may cause skipped beats or bradycardia.

传导阻滞  在心脏电脉冲的传导通路上,很多位置——比如在连接心房与心室的房室结附近,或是通向两个心室的通路(束支)上——都可能发生电信号的阻滞。不完全的阻滞会使电冲动传导减慢,而完全性的阻滞则会使传导停止。如果传导完全被阻断,房室结细胞或心室肌细胞接收不到上面传来的的指挥信号,就有可能揭竿造反——自己开始制造节律性的电冲动,并激动心室产生搏动。但这种搏动比正常的心跳慢得多,有时便可以引起漏搏,或是心动过缓。

Premature heartbeats
Although it often feels like a skipped heartbeat, a premature heartbeat is actually an extra beat. Premature heartbeats occurring in the ventricles come before the ventricles have had time to fill with blood after a regular heartbeat.
Although you may feel an occasional premature beat, it seldom means you have a more serious problem. Still, a premature beat can trigger a longer lasting arrhythmia — especially in people with heart disease. Premature heartbeats are commonly caused by stimulants, such as caffeine from coffee, tea and soft drinks; over-the-counter cold remedies containing pseudoephedrine; and some asthma medications.


早搏  虽说早搏的感觉与漏搏很相似,但本质上讲早搏是额外的搏动。正常情况下,心室肌舒张时血液从心房涌入心室,当心室充盈后心室肌开始收缩将血液泵至主动脉进而流向全身,有节奏地周而复始。如果心室肌突然出现了一个提早的收缩,而此时心室还没有被血液充分地充盈,  那么这一次收缩时泵至主动脉的血液就会减少。



Certain factors may increase your risk of developing an arrhythmia. These include:

危险因素    下列因素会增加患心律失常的危险,包括:

Coronary artery disease, other heart problems and previous heart surgery. Narrowed heart arteries, heart attack, abnormal valves, prior heart surgery, cardiomyopathy and other heart damage are risk factors for almost any kind of arrhythmia.
High blood pressure. This increases your risk of developing coronary artery disease. It may also cause the walls of your left ventricle to become stiff and thick, which can change how electrical impulses travel through your heart.
Congenital heart disease. Being born with a heart abnormality may affect your heart's rhythm.
Thyroid problems. Your metabolism speeds up when your thyroid gland releases too much thyroid hormone. This may cause fast or irregular heartbeats and may be linked to atrial fibrillation. Your metabolism slows when your thyroid gland doesn't release enough thyroid hormone, which may cause a bradycardia.
Drugs and supplements. Over-the-counter cough and cold medicines containing pseudoephedrine and certain prescription drugs may contribute to arrhythmia development.
Obesity. Along with being a risk factor for coronary artery disease, obesity may increase your risk of developing an arrhythmia.
Diabetes. Your risk of developing coronary artery disease and high blood pressure greatly increases with uncontrolled diabetes. In addition, episodes of low blood sugar (hypoglycemia) can trigger an arrhythmia.
Obstructive sleep apnea. This disorder, in which your breathing is interrupted during sleep, can cause bradycardia and bursts of atrial fibrillation.
Electrolyte imbalance. Substances in your blood called electrolytes, such as potassium, sodium, calcium and magnesium, help trigger and conduct the electrical impulses in your heart. Electrolyte levels that are too high or too low can affect your heart's electrical impulses and contribute to arrhythmia development.
Drinking too much alcohol. Drinking too much alcohol can affect the electrical impulses in your heart or increase the chance of developing atrial fibrillation. In fact, development of atrial fibrillation after an episode of heavy alcohol intake is sometimes called "holiday heart syndrome." Chronic alcohol abuse may cause your heart to beat less effectively and can lead to cardiomyopathy.
Caffeine or nicotine use. Caffeine, nicotine and other stimulants can cause your heart to beat faster and may contribute to the development of more-serious arrhythmias. Illegal drugs, such as amphetamines and cocaine, may profoundly affect the heart and lead to many types of arrhythmias or to sudden death due to ventricular fibrillation.
   ● 冠心病或其它心脏病,及心脏手术史。冠脉狭窄、心梗、心瓣膜病、手术史、心肌病和其他心脏损伤是绝大多数心律失常的危险因素。
   ● 高血压。它会增加患冠心病的危险。高血压还可以导致左心室壁肥厚、僵硬,由此影响电冲动的传导。
   ● 先天性心脏病。很多先心病都会影响心率。
   ● 甲状腺疾病。甲亢时新陈代谢加快,因而引起心跳过快或不规则,甚至房颤。甲减时则正好与之相反。
   ● 药物或补剂。成分中含有伪麻黄碱的非处方类感冒药,及一部分处方药都具有致心律失常作用。
   ● 肥胖。肥胖会增加患有冠心病的危险,由此导致心律失常。
   ● 糖尿病。糖尿病不加控制会大大增加患冠心病和高血压的危险。另外,时而的低血糖发作也可能引起心律失常。
   ● 阻塞性睡眠呼吸暂停综合征(OSAS)。此类患者睡眠时呼吸受阻,长期持续发作可能并发心动过缓或房颤。
   ● 电解质失衡。血液中电解质(比如钾钠钙镁离子)的浓度与心脏的电活动息息相关,它们一旦失去平衡就可能引起心率失常。
   ● 酗酒。过量摄入酒精会影响心脏的电活动并增加房颤的可能性——有时我们称之为”假日心脏综合症“。慢性酗酒可能使心脏搏动的效率下降,并引起心肌病。
   ● 咖啡因&尼古丁。这些物质会加速你的心跳,可能引起一严重的心率失常。违禁药物(比如安非他命、可卡因)对心脏的影响很大以至会引起多种心律失常——比如室颤(没吓人,接着就是猝死了)。   

Complications
Certain arrhythmias may increase your risk of developing conditions such as:

并发症    心律失常可能导致:

Stroke. When your heart quivers, it's unable to pump blood effectively, which can cause blood to pool. This can cause blood clots to form. If a clot breaks loose, it can travel to and obstruct a brain artery, causing a stroke. This may damage a portion of your brain or lead to death. For people who have atrial fibrillation, the medications warfarin (Coumadin) or dabigatran (Pradaxa) may help prevent blood clots, which can cause a stroke.

中风  心脏颤动的时候无法有效地泵血,从而使血液停滞不前,进而引起凝血。如果一个血凝块从心脏上掉了下来,它就会顺着血流进入体循环,如果卡在了脑动脉就可能导致中风。华法林、达比加群等药物可以对抗凝血,降低中风的发生率。

Heart failure. This can result if your heart is pumping ineffectively for a prolonged period due to a bradycardia or tachycardia, such as atrial fibrillation. Sometimes, controlling the rate of an arrhythmia that's causing heart failure can improve your heart's function.

心衰  持续的心率失常(比如房颤)会使心脏在很长时间里无法有效地泵血,从而引起心衰。有时,控制心率能够改善心律失常患者的心功能。



  
If you think you may have a heart arrhythmia, make an appointment with your family doctor. If a heart arrhythmia is found early, your treatment may be easier and more effective. Eventually, however, you may be referred to a heart specialist (cardiologist).
If your heart arrhythmia persists for more than a few minutes or is accompanied by fainting, shortness of breath, or chest pain, seek emergency medical help immediately.
Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.

预约就诊

   如果你发现自己心律失常持续超过几分钟而且觉得要晕倒、气短或是胸闷胸痛,速叫急救。

   如果觉得自己可能患有心律失常,请预约你的家庭医生。发现越早,往往治疗就越简单有效。不过,你可能最后还是要去医院看门诊。

   因为家庭医生的接诊时间有限,而且有很多相关事情都需要考虑,你最好提早进行一些准备,包括:

What you can do
Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet. You may need to do this if your doctor orders any blood tests.
Write down any symptoms you're experiencing, including any that may seem unrelated to heart arrhythmia.
Write down key personal information, including a family history of heart disease, stroke, high blood pressure or diabetes, and any major stresses or recent life changes.
Make a list of all medications, as well as any vitamins or supplements, that you're taking.
Take a family member or friend along, if possible. Sometimes it can be difficult to understand and remember all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.

    ● 提前做好检查时需要的限制。预约就诊时,问好你需要提前做的事情,比如限食(做血液检查的话可能会需要)。

    ● 写下所有你感觉到的症状,哪怕你觉得它与心率失常无关。

    ● 写下重要的个人信息,包括以下这些疾病的家族史:心脏病、中风、高血压、糖尿病;以及你所面临的主要压力,和近期的生活变化。

    ● 写下所有你在服用的药品、维生素、补品。

    ● 如果可能,带着家人或朋友一起去。你自己可能难以完全理解并记下医生告诉你的事情。
Write down questions to ask your doctor.

 

Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important, in case time runs out. For heart arrhythmias, some basic questions to ask your doctor include:

  

§ 写下你想问医生的问题。 

   和医生交流的时间是有限的,预备一个问题清单会帮助你有效利用这段时间。把问题依重要性排列,以免时间不够。关于心律失常,一般你需要问:

What is likely causing my symptoms or condition?
What are other possible causes for my symptoms or condition?
What kinds of tests will I need?
What's the best treatment?
What foods should I eat or avoid?
What's an appropriate level of physical activity?
How often should I be screened for heart disease or other complications of an arrhythmia?
What are the alternatives to the primary approach that you're suggesting?
I have other health conditions. How can I best manage them together?
Are there any restrictions that I need to follow?
Should I see a specialist?
Is there a generic alternative to the medicine you're prescribing?
Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment.
   ● 我最可能的病因是什么?
   ● 还有其他可能的病因吗?
   ● 我还需要做哪些检查?
   ● 最好的治疗是什么?
   ● 哪些食物我该多吃,哪些不该吃?
   ● 我应该维持何种程度的体力活动?
   ● 我应该隔多长时间检查(心脏病和其他并发症)一次?
   ● 有没有其他的方法?
   ● 我还有其他健康问题。如何兼顾?
   ● 有什么限制或禁忌吗?
   ● 我该去看专科医生吗?药物有其他类别的选择吗?
   ● 有没有指南之类我可以带回家的东东?有推荐给我看的网站吗?

有问题就问,不要犹豫。

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:


§ 医生会问什么?

   医生会问你很多问题,提前准备好会帮你节省时间以留给重点。他/她可能会问:

When did you first begin experiencing symptoms?
Have your symptoms been continuous, or occasional?
How severe are your symptoms?
What, if anything, seems to improve your symptoms?
What, if anything, appears to worsen your symptoms?
   ● 症状是何时出现的?
   ● 症状是持续的,还是偶尔的?
   ● 症状有多严重?
   ● 有没有什么可以减轻或加重症状? 
Tests and diagnosis
To diagnose a heart arrhythmia, your doctor may ask about — or test for — conditions that may trigger your arrhythmia, such as heart disease or a problem with your thyroid gland. Your doctor may also perform heart-monitoring tests specific to arrhythmias. These may include:



检查与诊断

    为了作出诊断,医生会询问你——或是测试——一些可能引起你心率失常的状况,比如心脏病或甲状腺疾病。当然也有一些针对心率失常的检查,包括:
Electrocardiogram (ECG). During an ECG, sensors (electrodes) that can detect the electrical activity of your heart are attached to your chest and sometimes to your limbs. An ECG measures the timing and duration of each electrical phase in your heartbeat.

心电图(ECG)  做心电图时,接在你的胸口和/或四肢的电极会探测心脏的电活动:它们会测量每次心搏的时限、相位等数据。

Holter monitor. This portable ECG device can be worn for a day or more to record your heart's activity as you go about your routine.

动态心电图  这是一种可随身携带的心电图,可以在你正常生活时连续记录下几天内心脏的电活动。

Event monitor. For sporadic arrhythmias, you keep this portable ECG device at home, attaching it to your body and using it only when you have symptoms of an arrhythmia. This lets your doctor check your heart rhythm at the time of your symptoms.

(心律失常)事件监测仪  对于偶尔发作的心律失常患者,可以把这东东放在家里,然后在症状出现时挂在身上。这样医生就可以检查发病时的心率了。

Echocardiogram. In this noninvasive test, a hand-held device (transducer) placed on your chest uses sound waves to produce images of your heart's size, structure and motion.

超声心动图  这种无创的检查是把一个手持的探头放在你的胸壁上并通过超声波显示心脏的大小、结构和运动。

Cardiac computerized tomography (CT) or magnetic resonance imaging (MRI). Although more commonly used to check for heart failure, these tests can be used to diagnose heart problems that might cause heart arrhythmias. In a cardiac CT scan, you lie on a table inside a doughnut-shaped machine. An X-ray tube inside the machine rotates around your body and collects images of your heart and chest.
In a cardiac MRI, you lie on a table inside a long tube-like machine that produces a magnetic field. The magnetic field aligns atomic particles in some of your cells. When radio waves are broadcast toward these aligned particles, they produce signals that vary according to the type of tissue they are. The signals create images of your heart that can help your doctor determine the cause of your heart arrhythmia.
CT(断层扫描)& MRI(磁共振)  它们更常用于心衰的检查,但也可用来检查一些引起心律失常的心脏病。

   做CT时,你躺在一架形似甜甜圈的机器里的一个平台上。机器里面的一个X线管围着你的身体旋转并采集图像。 

   做MRI时,你躺在一架管状机器里的一个平台上。 机器会产生磁场,后者使一些细胞内原子核的自旋产生变化(从无序变得有序)。这时对它们发射一定频率的电磁波就会使它们发出各种不同的信号(信号因组织的不同而不同)。通过检测信号就可以对心脏成像并帮助医生推测病因。
If your doctor doesn't find an arrhythmia during those tests, he or she may try to trigger your arrhythmia with other tests, which may include:


如果以上检查都没有发现心律失常,医生可能会通过一些方法激发心律失常,比如:

Stress test. Some arrhythmias are triggered or worsened by exercise. During a stress test, you'll be asked to exercise on a treadmill or stationary bicycle while your heart activity is monitored. If you have difficulty exercising, your doctor may use a drug to stimulate your heart in a way that's similar to exercise.

应激试验(负荷试验)  运动会加重一些心率失常。医生会让你踩踏板,与此同时检测心脏活动。对于不便运动的患者,医生会用药物以达到运动的效果。

Tilt table test. Your doctor may recommend this test if you've had fainting spells. Your heart rate and blood pressure are monitored as you lie flat on a table. The table is then tilted as if you were standing up. Your doctor observes how your heart and the nervous system that controls it respond to the change in angle.

倾斜试验  对有晕厥症状的患者,医生会建议做这个检查。你会平躺在一张平板上,平板从水平位转至近似竖直位,最后你会觉得好像是在站着。医生会观察角度变化时心血管系统和神经系统的反应。

Electrophysiological testing and mapping. In this test, thin, flexible tubes (catheters) tipped with electrodes are threaded through your blood vessels to a variety of spots within your heart. Once in place, the electrodes can map the spread of electrical impulses through your heart. In addition, your cardiologist can use the electrodes to stimulate your heart to beat at rates that may trigger — or halt — an arrhythmia. This allows your doctor to see the location of the arrhythmia and what may be causing it.

电生理检查与定位  此检查将载有电极的柔韧导管通过血管插入心脏内的不同部位。电极就位后,便可以绘制心脏电脉冲活动与传导的详细情况。另外,心脏专科医生也可以通过电极刺激心脏,以此引发或消除异常心律;这样就可以对病灶进行定位了。


Treatments and drugs
If you have an arrhythmia, treatment may or may not be necessary. Usually it's required only if the arrhythmia is causing significant symptoms or if it's putting you at risk of a more serious arrhythmia or arrhythmia complication.

治疗与药物

对于一部分心率失常的患者来说,治疗的意义并不大。通常只有症状严重或可能引起严重的并发症时才考虑常规治疗。

Treating slow heartbeats
If slow heartbeats (bradycardias) don't have a cause that can be corrected — such as low thyroid hormone levels or a drug side effect — doctors often treat them with a pacemaker. A pacemaker is a small, battery-powered device that's usually implanted near your collarbone. One or more electrode-tipped wires run from the pacemaker through your blood vessels to your inner heart. If your heart rate is too slow or if it stops, the pacemaker sends out electrical impulses that stimulate your heart to beat at a steady, proper rate.

心动过缓的治疗

   如果导致心动过缓的病因无法矫正——比如甲减、或某些药物的副作用——起搏器常常是最佳的选择。起搏器是一种电池驱动的小玩意,植入锁骨附近。它发出一根或多根电极导线,后者穿过血管进入心脏。当心跳过慢或停止时,起搏器就会发出电脉冲,通过导线刺激心脏按照设定的频率跳动。

Treating fast heartbeats
For fast heartbeats (tachycardias), treatments may include one or more of the following:

心动过速的治疗    有以下多种方法:

Vagal maneuvers. You may be able to stop an arrhythmia that begins above the lower half of your heart (supraventricular tachycardia, or SVT) by using particular maneuvers that include holding your breath and straining, dunking your face in ice water, or coughing. Your doctor may be able to recommend other maneuvers to halt a fast heartbeat. These maneuvers affect the nervous system that controls your heartbeat (vagus nerves), often causing your heart rate to slow.

迷走神经刺激法  这类方法可能会中止室上性心动过速。包括:深吸气后屏住然后再用力呼气(Valsalva动作);将面部浸于冷水中;刺激咽喉诱导咳嗽或恶心;按压眼球等。医生可能还会告诉你一些其他的方法,记好。这些方法通过刺激迷走神经而减慢心率。

Medications. Many types of tachycardias respond well to anti-arrhythmic medications. Though they don't cure the problem, they can reduce episodes of tachycardia or slow down the heart when an episode occurs. Some medications can slow down your heart so much that you may need a pacemaker. It's very important to take any anti-arrhythmic medication exactly as directed by your doctor, in order to avoid complications.

药物  很多种心动过速对 抗心律失常药物反应敏感。虽然药物不能根治此类疾病,它们却可以减少心动过速的发生,并降低发生时的心率。一些药物甚至是矫枉过正——而需要依赖起搏器。服用任何抗心律失常药物,哪怕是停药,都要谨遵医嘱,否则并发症可能很严重!

Cardioversion. If you have a tachycardia that starts in the top half of your heart (atria), including atrial fibrillation, your doctor may use cardioversion, which is an electrical shock used to reset your heart to its regular rhythm. Usually this is done externally in a monitored setting, and you're given medication to relax you during the procedure, so there's no pain involved.

心脏电复律  对于房性心动过速(比如房颤),医生可能会采用心脏电复律——这种方法通过电击使心脏恢复正常节律。复律一般都在体外实施并设有监测装置,还会有药物帮助你放松,所以是无痛的。

Ablation therapy. In this procedure, one or more catheters are threaded through your blood vessels to your inner heart. They're positioned on areas of your heart that your doctor believes are the sources of your arrhythmia. Electrodes at the catheter tips are heated with radiofrequency energy. Another method involves cooling the tips of the catheters, which freezes the problem tissue. Either method destroys (ablates) a small spot of heart tissue and creates an electrical block along the pathway that's causing your arrhythmia. Usually this stops your arrhythmia.

消融术  这种方法将一个或多个导管通过血管穿入心脏并定位于引起心率失常的病灶处。导管内的电极会对病灶释放射频电流并转化为热能。另一种方法则是对导管尾部附近的组织进行冷冻。二者都会除掉一小块心脏组织,并在此处阻断导致心率失常的异常电传导。消融术常可根治心律失常。

Implantable devices
Treatment for heart arrhythmias also may involve use of an implantable device:

植入设备    心率失常的治疗也包括植入性设备的应用:

Pacemaker. A pacemaker is an implantable device that helps regulate slow heartbeats (bradycardia). A small battery-driven device is placed under the skin near the collarbone in a minor surgical procedure. An insulated wire extends from the device to the right side of the heart, where it's permanently anchored.
If a pacemaker detects a heart rate that's too slow or no heartbeat at all, it emits electrical impulses that stimulate your heart to speed up or begin beating again. Most pacemakers have a sensing device that turns them off when your heartbeat is above a certain level. It turns back on when your heartbeat is too slow. Most people stay in the hospital one to two days after a pacemaker is implanted.

起搏器  像前面介绍的那样,起搏器植入锁骨附近的皮下,并发出导线连接心脏的右侧(多腔起搏器也有植入左侧的导线)。当心跳正常时,起搏器就会关闭;而一旦跳慢了,它就会开启。一般来说,刚刚植入起搏器后要留在医院观察一两天。

Implantable cardioverter-defibrillator (ICD). Your doctor may recommend this device if you're at high risk of developing a dangerously fast or quivering heartbeat in the lower half of your heart (ventricular tachycardia or ventricle fibrillation). Implantable defibrillator units designed to treat quivering in the upper half of your heart (atrial fibrillation) also are available.
An ICD is a battery-powered unit that's implanted near the left collarbone. One or more electrode-tipped wires from the ICD run through veins to the heart. The ICD continuously monitors your heart rhythm. If it detects a rhythm that's too slow, it paces the heart as a pacemaker would. If it detects VT or VF, it sends out low- or high-energy shocks to reset the heart to a normal rhythm.

植入式心脏复律除颤器(ICD)  对可能会由于室性心律失常导致危险性室速或室颤的高危患者,医生会推荐ICD。当然也有针对房颤的ICD。

   ICD植入于左侧锁骨附近,并发出电极导线穿过静脉进入心脏。它持续监测心跳节律,如果心跳过慢就像起搏器一样发挥作用,如果出现室速或室颤它就会发射不同能量的除颤电流,使心率恢复正常。

Surgical treatments
In some cases, surgery may be the recommended treatment for heart arrhythmias:

外科治疗    有时,外科手术会应用于心率失常的治疗。

Maze procedure. This involves making a series of surgical incisions in the upper half of your heart (atria). These heal into carefully placed scars in the atria that form boundaries that force electrical impulses in your heart to travel properly to cause the heart to beat efficiently. The procedure has a high success rate, but because it requires open-heart surgery, it's usually reserved for people who don't respond to other treatments. The surgeon may use a cryoprobe — an instrument for applying extreme cold to tissue — or a hand-held radiofrequency probe, rather than a scalpel, to create the scars.

迷宫术。它包括对心房的一系列切割。切口愈合形成瘢痕后,就会形成很多屏障,使得心脏电冲动按照正确的路线传导。这种手术成功率高,但需要开胸操作,所以往往只适合于那些其他治疗无效的患者。外科医生会用冷刀(一种使组织极度冷却的家伙)或手持的射频探头——而非手术刀——去制造伤疤。 

Ventricular aneurysm surgery. In some cases, a bulge (aneurysm) in a blood vessel leading to the heart is the cause of an arrhythmia. If catheter ablation and implanted ICD don't work, you may need this surgery. It involves removing the aneurysm that's causing your arrhythmia. By removing the source of the abnormal impulses, the arrhythmia often can be eliminated.

室壁瘤手术。有时,室壁瘤(心室壁某处的膨出)会导致心律失常。如果导管消融术和ICD都不起作用,患者就需要进行这个手术。手术会除去这个室壁瘤,也就消除了导致心律失常的病根,心律往往就会恢复正常。

Coronary bypass surgery. If you have severe coronary artery disease in addition to frequent ventricular tachycardia, your doctor may recommend coronary bypass surgery. This may improve the blood supply to your heart and reduce the frequency of your ventricular tachycardia.

冠脉搭桥手术  对于经常性室速合并严重冠心病的患者,医生会建议这个手术。它会改善心脏自身的血液供应,并减少室速的发生次数。

Lifestyle and home remedies
Many arrhythmias can be blamed on underlying heart disease, so your doctor may suggest that, in addition to other treatments, you make lifestyle changes that will keep your heart as healthy as possible. Making healthy lifestyle changes can also help prevent heart arrhythmias from developing in the first place.
These lifestyle changes may include:


  

生活方式与家庭疗法

因为很多心律失常都源自潜在的心脏疾病,医生会建议你做一些有益于心脏健康的生活方式改变——它们也可以帮助你预防心律失常本身。包括:

Eat heart-healthy foods.
Increase your physical activity.
Quit smoking.
Cut back on caffeine and alcohol.
Find ways to reduce the amount of stress in your life.
Avoid stimulant medications, such as medications found in over-the-counter treatments for colds and nasal congestion.

   ● 吃对心脏健康有益的食物。
   ● 加大运动量。
   ● 戒烟。
   ● 减少咖啡和酒精的摄入。
   ● 减少生活压力。
   ● 避免服用一些刺激性药物,比如前面提到的非处方类感冒药。