运动和心律失常(2015).pdfVIP

运动和心律失常 • 运动相关的心脏结构改变可能会引起频繁及 复杂室性心律失常，而引起运动员猝死。 • 美国明尼苏达州，调查12年内参与27项运动 的140万名学生运动员，高中生猝死发生率 约为1/10万（男性）和1/30万（女性），大 学生运动员其发生率增加（1/6.5～6.9万）。 • 运动相关性猝死的基础病因主要为心肌病、 早期冠心病和先天冠脉发育异常等。35岁以 上的运动员猝死以冠心病为主要病因，而年 轻运动员病因以肥厚性心肌病为主。 运动性猝死(exercise Athletic sudden death) ：在运动过程中 或运动后24小时内发生的非创伤性意外死亡。 • 运动员心血管异常筛查体系： • 详细的个人病史 • 家族史 • 体格检查 • 12导心电图 Electrical conduction in the Heart • The Sinoatrial node (SA node), is a group of autorhythmic cells (main pacemaker of the heart) in the right atrium near the entry of the superior vena cava. • An internodal pathway connects the SA node to the atrioventricular node (AV node), a group of autorhythmic cells found near the floor of the right atrium. • From the AV node action potentials move into fiber known as the bundles of his or atrioventricular bundle. The bundle passes from the AV node into the wall of the septum between the ventricles. • A short way down the septum the bundle divides into left and right bundle branches. • These fibers continue downward to the apex where they divide into many small purkinje fibers that spread outward among the contractile cells. Heart Rhythm Bundle of His AV node Bundle Branches Purkinje Fibers 心脏的传导系统 心脏的传导系统由窦房结、 结间束、房间束、房室结、希氏 束 （His bundle）、左束支、右 束支及蒲肯野 （Purkinje）纤维 网构成。 Conduction Velocity of Heart Tissue Atrial tissue = 1.0 m/s AV node = 0.03 m/s Bundle of His Bundle branches = 5.0 m/s Purkinje fibers The Electrocardiogram Electrocardiography (ECG, EKG) exploits the fact that: 1. Body tissue