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心房颤动房颤Atrial fibrillation目录心房颤动房颤 Atrial fibrillation1流行病学 1Overview2Symptoms 3When to see a doctor 4病因 5Causes 5Possible causes of atrial fi b ri l l a t i o n 7Atrial flutter7Risk factors 8Complications9Prevention9心房颤动（房颤）是指规则有序的心房电活动丧失，代之以快速无序的心房颤动波，是 最严重的心房电活动紊乱，也是常见的快速性心律失常之一，是最常见的持续性心律失常之 一，房颤总的发病率为0.4%，随着年龄增长房颤的发生率不断增加，75岁以上人群可达10%。 流行病学在普通人群中房颤的患病率约为0.4%-1.0%。 房颤的患病随着年龄的增加而增加，小于 60岁的人群患病率较低，而80岁以上的人群可髙达8%。40 岁以下者房颤的发病率为0.1%/ 年，80岁以上的男性和女性房颤的发病率分别为2%/年和1.5%/年。房颤患者远期脑卒中、心力衰竭和全因死亡率风险增加，特别是女性患者。与窦性心律者 相比，房颤患者的死亡率增加一倍。非瓣膜性房颤患者缺血性卒中的发生率为5%/年,是无 房颤者的2-7倍。若考虑短暂脑缺血发作(TIA)和无症状的脑卒中，伴随房颤的脑缺血发作的 发生率为7%/年。与年龄匹配的对照者相比，房颤的风湿性心脏病患者发生脑卒中的风险增 加17倍；与非风湿性房颤患者相比，风险增加5倍。房颤患者栓塞发生率随着年龄的增加而 增加，50-59岁患者因房颤所致的脑卒中每年发生率为1.5%，而80-89岁者则升高到23%。 男性患者栓塞发病率在各年龄段均高于女性。房颤的总患病率、年龄分组、性别分组、病因分组后的患病率均和国外相关资料的趋势 接近。中国因房颤而住院的患者也有增加的趋势。随着我国人口的老龄化，房颤的负担无疑 会越来越重。我国房颤患者并发脑卒中的发生情况也与国外类似。在平均70岁的非瓣膜病 房颤患者中，缺血性脑卒中的发生率为5.3%，与欧美国家相似(4%6%)。住院患者房颤的 脑卒中患病率达24.8%，且有明显随年龄增加趋势，80岁以上脑卒中患病率高达32.9%。Heart palpitations and shortness of breathOverviewAtrial is a fibrillati onn irregular and often rapid heart rate that can in crease your risk of strokes, heart failure and other heart-related complicati ons.During atrial fibrillation, the heart's two upper chambers (the atria) beat chaotically and irregularly out of coordination with the two lower chambers (the ventricles) of the heart. Atrial fibrillation symptoms often include heart palpitations, shortness of breath and weakness.Episodes of atrial fibrillation may come and go, or you may develop atrial fibrillation that doesn't go away and may require treatment. Although atrial fibrillation itself usually isn't life-threatening, it is a serious medical condition that sometimes requires emergency treatment.A major concern with atrial fibrillation is the potential to develop blood clots within the upper chambers of the heart. These blood clots forming in the heart may circulate to other organs and lead to blocked blood flow (ischemia).Treatments for atrial fibrillation may include medications and other interventions to try to alter the heart's electrical system.SymptomsSome people with atrial fibrillation have no symptoms and are unaware of their condition until it's discovered during a physical examination. Those who do have atrial fibrillation symptoms may experience signs and symptoms such as:Palpitations, which are sensations of a racing, uncomfortable, irregular heartbeat or a flip-flopping in your chestWeaknessReduced ability to exerciseFatigueLightheadednessDizzinessShortness of breathChest painAtrial fibrillation may be:Occasional. In this case it's called paroxysmal (par-ok-SIZ-mul) atrial fibrillation. You may have symptoms that come and go, usually lasting for a few minutes to hours. Sometimes symptoms occur for as long as a week and episodes can happen repeatedly. Your symptoms might go away on their own or you may need treatment.Persistent. With this type of atrial fibrillation, your heart rhythm doesn't go back to normal on its own. If you have persistent atrial fibrillation, you'll need treatment such as an electrical shock or medications in order to restore your heart rhythm.Long-standing persistent. This type of atrial fibrillation is continuous and lasts longer than 12 months.Permanent. In this type of atrial fibrillation, the abnormal heart rhythm can't be restored. You'll have atrial fibrillation permanently, and you'll often require medications to control your heart rate and to prevent blood clots.When to see a doctorIf you have any symptoms of atrial fibrillation, make an appointment with your doctor. Your doctor may order anelectrocardiogram to determine if your symptomsare related to atrial fibrillation or another heart rhythm disorder (arrhythmia).If you have chest pain, seek emergency medical assistance immediately. Chest pain could signal that you're having a heart attack.1. 房颤的急性原因 房颤与某些急性、暂时性原因有关，包括饮酒、外科手术、电击、心肌炎、肺栓塞、其 它肺脏病以及甲状腺机能亢进，治疗基础疾病可以消除房颤。房颤是心肌梗塞和心胸外科手 术后较常见的早期并发症。2. 不伴有相关心血管疾病的房颤 年轻患者中，大约30%（45%的阵发性房颤和20%（25%的持续性房颤属于孤立性房颤。3. 伴有相关心血管病的房颤与房颤有关的心血管病包括瓣膜性心脏病（大多为二尖瓣性）、冠心病（CAD ）以及高 血压，尤其是存在左室肥厚（LVH ）时。4. 神经性房颤 自主神经系统通过提高迷走神经或交感神经张力可以触发易感病人发生房颤。许多患者 房颤发作都是出现在迷走神经和交感神经张力增强的时候。Coumel描述了一组病人，并将其 分为迷走型房颤和交感型房颤。纯粹迷走型房颤或交感型房颤患者比较少见，但是如果患者 有某型房颤发作史以及相关特征性症状之一，那么临床医师选用相应药物才能更有效地防止 反复发作。CausesWiuiCuLaf imwi理 BAtrial fibrillation is an irregular and often rapid heart rate that occurs when the two upper chambers of your heart experie nee chaotic electrical sig nals. The result is a fast and irregular heart rhythm. The heart rate in atrial fibrillation may range from 100 to 175 beats a minu te. The n ormal range for a heart rate is 60 to 100 beats a minu te.Your heart is made up of four chambers 一 two upper chambers (atria) and two lower chambers (ven tricles). With in the upper right chamber of your heart (right atrium) is a group of cells called the sinus no de. This is
