急性右心室心梗合并心源性休克的急救与护理

目的探讨急性右心室心梗合并心源性休克的急救与护理。方法对6例急性右心室心梗合并心源性休克的临床资料进行回顾性分析。结果 4例好转出院,2例死亡。结论掌握休克的特殊性、灵活地根据血液动力学变化调节各种液体的输入,同时应注意监测休克好转的各项指标,重视基础护理,可最大限度地提高患者的抢救成功率。

致心律失常右心室心肌病

致心律失常性右心室心肌病（ARVC）是一种主要累及右心室心肌组织的疾病,过去国内报道较少,与对该病认识不足有关。近年来,随着医疗技术水平的不断提高,对该病的研究特别在诊断手段和治疗上有很大进展。一、概况致心律失常性右心室心肌病（arrhythmogenic right ven-tricular cardiomyopathy,ARVC）,也称致心律失常性右心室发育不良（arrhythmogenic right ventricular dysplasia,ARVD）,最早于1961年由Dalla描述,但作为疾病由Frank等于1978年首先定名,被定义为累及右心室的原因不明心肌病。

探讨中青年急性右心室心梗护理中心理护理的应用效果

目的观察在中青年急性右心室心梗护理中采取心理护理的应用效果分析。方法将我院心内科近期(2018年06月-2018年12月时期)收治中青年急性右心室心梗患者总计80例,采取随机数字法分成常规组(40例)与心理组(40例),其中常规组采取常规心内科护理干预,心理组患者在对照组基础上采取心理护理干预。对照两组患者护理前、后负性情绪评分,护理效果、不良事件发生率比较。结果护理后两组患者负性情绪评分均有所下降,其中心理组SDS、SAS评分明显少于常规组,护理效果总有效心理组与常规组为(100%&12.5%),不良事件发生率(0%&10%),差异具有统计学意义(P<0.05)。结论在青年急性右心室心梗护理中,采取心理护理干预,可明显减少患者护理后负性情绪,提高护理效果,减少治疗护理中不良事件的发生率,效果理想。

中青年急性右心室心梗护理中心理护理的应用效果

探讨心理护理在急性右心室心梗中的应用作用。方法:将我院44例急性右心室心梗患者(于2019年7月~2020年1月间)纳入研究,用计算机进行随机分组,分为参照组(n=22)、实验组(n=22),对参照组实施常规护理,对实验组实施“常规+心理”护理,分析效果。结果:实验组焦虑及抑郁评分、住院时间与参照组之间对比更少,差异显著(P<0.05);实验组治疗效果与参照组组间对比更好,差异显著(P<0.05)。结论:心理护理在急性右心室心梗中的应用优势明显,值得临床推广。

彩色多普勒超声心动图对右心室双腔心的诊断价值

目的回顾探讨彩色多普勒超声心动图在右心室双腔心中的诊断价值。方法比较右心室双腔心手术患者22例的术前彩色多普勒超声心动图诊断和术后结果。结果超声心动图诊断和术后诊断符合率95%(21/22),其中2例为单纯右心室双腔心,20例右心室双腔心合并室间隔缺损,2例右心室双腔心合并肺动脉瓣狭窄。结论彩色多普勒超声心动图诊断右心室双腔心及其合并症的主要手段,具有安全、准确、直接的优点。

右室不同部位起搏的临床观察

目的:观察右室不同部位起搏对心室重构和心功能的影响.方法:所选患者均植入人工双腔永久起搏器.据右室电极植入部位的不同分为右室心尖部起搏组和右室间隔部起搏组.常规彩超测定左室射血分数、心输出量、室间隔厚度;应用组织多普勒测量室间隔及左室基底段、心尖段的收缩达峰时间;BNP的变化.随访时间18个mo.结果:两组间比较,LVEF,CO无显著性差异(P≥0.05),室间隔厚度出现差异(P≤0.05).应用组织多普勒测量两组间不同节段的收缩达峰时间存在差异(P≤0.05).间隔部起搏组BNP低于右室心尖部起搏组,差异有统计学意义(P≤0.05).结论:长期心尖部起搏较易引起心室重构,BNP的升高,在观察过程中尚未发现心功能的下降.

Relationship between lipidslevelsand right ventricular volume overload in congestive heart failure

BackgroundThe relationship between lipids and coronary artery disease has been well established. However, this is not the case between lipids and heart failure. Ironically, high lipid levels are associated with better outcomes in heart failure, but the mechan-isms underlying the phenomenon are not fully understood. This study was performed to test the hypothesis that reduced intestinal lipid absorption due to venous congestion may lead to low lipid levels.MethodsWe collected data of clinical characteristics, echocardio-graph, and lipid profile in 442 unselected patients with congestive heart failure. Correlations between lipid levels[including total cho-lesterol（TCL）, high-density lipoprotein cholesterol（HDL-C）, low-density lipoprotein cholesterol（LDL-C）, and triglycerides（TG）]and right ventricle end diastolic diameter （RVEDD）, left ventricle end diastolic diameter （LVEDD）, right atrium diameter （RA）, left atrium diameter （LA）, or left ventricle ejection fraction （LVEF） were analyzed using Pearson correlation and partial correlation. RVEDD, LVEDD, RA, and LA were indexed to the body surface area.ResultsThere was a significantly inverse correlation between TCL le-vels and RVEDD （r=-0.34,P〈0.001） and RA （r=-0.36,P〈0.001）. Other lipids such as LDL-C, HDL-C, and TG had asimilar inverse correlation with RVEDD and RA. All these correlations remained unchanged after adjusting for age, gender, smoking status, physical activity levels, comorbidities, and medication use.ConclusionsLipid levels were inversely correlated to RVEDD in patients with congestive heart failure; however, because this was an observational study, further investigation is needed to verify our results as wellas identify a causal relationship, if any.

RADIOFREQUENCY ABLATION OF IDIOPATHIC RIGHT VENTRICULAR TACHYCARDIA

This paper presents our experience with radioreqencey ablation (RFA) for idiopathic ventricular tachycardia (VT) arising from right ventricle in 12 patients (pts.). The age range of patients was 21-50, with a mean of 38.5 years. Ten out of 12 were females, 1 patient had candia failure due to almost incessant VT while the rest had normal left ventricular function. Twelve pts had VT arising from the right ventricle; of those, 9 were from the outflow truct, 2 from the RV apex, and 1 from the RV inflow. In all pts the diagnostic study and therapeutic RFA were combined in a single procedure. Pacemapping and local activition time were used to guide the site of RFA in pts with VT arising from the right ventricle. RFA was successful in 11 of the 12 pts(91 % ). Number of RF applications were 1 -27, mean 9. 6;fluo- roscopy time were 4-75, mean 26. 9 minutes. RFA for idiopathic RV has a high success rate. This mode of treatment should be considered as a nonpharmacological curative treatment for symptomatic pts.

Effects of Long-term Right Ventricular Apical Pacing on Left Ventricular Remodeling and Cardiac Function

Objective: To investigate the impacts of long-term right ventricular apical pacing on the ventricular remodeling and cardiac functions of patients with high-grade and third-degree atrioventricular blockage with normal heart structures and cardiac functions. In addition, we provide many evidences for choosing an optimal electrode implantation site.Methods: Study participants included patients who were admitted for pacemaker replacements and revisited for examinations of implanted pacemakers at outpatient. Pacemakers were implanted to treat high-grade and third-degree atrioventricular blockage. At the time of pacemaker implantation, patients had normal cardiac functions and showed no serious heart diseases or cardiac dilatation. The durations from the implantation to follow-up were more than 5 years. The pacing rate was higher than 80%. Patients with a left ventricular ejection fraction (LVEF) < 50% and a left ventricular end-diastolic diameter (LVEDD) > 55 mm were excluded. Ventricular remodeling was defined as follows:increase of LVEDD by 10% and a reduction of LVEF by 25% for five years after implantation. Cardiac functions were evaluated according to New York Heart Association (NYHA) classification.Results:A total of 82 patients with a mean age of (66.97±13.19) years (range, 12 to 91 years old),among which 39 male and 43 female were enrolled in this study. The average duration between two assessments was 8.7 years (104.4 months). Before pacemaker implantation, the average left atrial diameter (LA), LVEDD and LVEF were 37.0 mm, 50.23 mm and 64.87%, respectively. After the implantation, these values were 39.39 mm (P=0.000163), 50.82 mm (P=0.177842) and 60.50% (P=0.000104), respectively. Four patients (4.87%) had ventricular remodeling with deteriorations of cardiac function, three of which had anterior wall myocardial infarction after implantation and one had type II diabetes. Clinical symptoms of heart failure were not found among the patients who did not exhibit ventricular remodeling. Conclusion: Through a long-period follow-up study, we found that long-term right ventricular apical pacing in patients with normal heart structure and cardiac function would not generally cause ventricular remodeling and clinical deteriorations of cardiac function. Right ventricular apical is a safe and effective site for pacing electrode wire implantation.

Pathological study on right atrium myocardium in rheumatic heart disease patients with atrial fibrillation

Objective: To study the pathological basis of right atrial fibrillation in rheumatic heart disease (RHD) patients with atrial fibrillation (AF). Methods: Twenty-nine patients with mitral valve replacement of RHD were divided into AF group (n=13) and sinus rhythm group (SN group) (n=16). There was no significant statistical difference in clinical factors between the 2 groups. During the operation of valve replace-ment, the samples of right atrial appendages were taken and the qualitative and quantitative study were made by light microscopy and electron microscopy. Results: (1) Light microscope: The interstitial fibrosis and the arrangement of myocardium was more disordered in AF group than that in SN group. However, no statistic difference was found in interstitial fibrosis and cellar hypertrophy degree between the 2 groups. (2) Electron microscope: Mitochondrial crosta broke and dissolved obviously in AF group. The mitochondrial volume in AF group was smaller than that in SN group. Volume density, average area and average perimeter in AF group were less than that in SN group ; specific surface in AF group was bigger than that in SN group. There was significant difference of above factors between the 2 groups; but there was no significant difference of surface density and numerical density on area in the 2 groups. Volume density of myofibril in AF group and SN group were less than that in SN group. (3)Split of Intercalated disc(ID) gap was found in AF group, and there was marrowing and floccular substance in ID gap. Conclusion : There were significant differences in the pathological changes of right atrial myocardium between AF and SN with RHD, these changes may be the im-portant pathological basis for RA fibrillation of AF patients with RHD.

Clinical and familial study of arrhythmogenic right ventricular cardiomyopathy

Objective To explore the characteristics of arrhythmogenic right ventricular cardiomyopathy (ARVC) Methods Seven patients with arrhythmogenic right ventricular cardiomyopathy and 34 members of three families were studied All patients and family members underwent history collection, clinical examination, electrocardiogram (ECG), two dimensional echocardiography (2 DE) and a signal averaging electrocardiogram Programmed ventricular stimulation was performed in five patients Results All patients and family members had normal morphologic characteristics and normal function of the left ventricular by 2 DE Fourteen persons had abnormal findings indicating ARVC Five had enlargement of the right ventricular with diffused hypocontractility, eight had thin and systolic bulging in the focal anterior wall with hypokinesia and one had bulging of the inferior wall Twenty five persons (seven patients and 18 family members) had abnormal findings in ECG Positive ventricular late potential was recorded in 13 persons (six patients) Two to three monomorphic ventricular tachycardia (VT) with left bundle branch block (LBBB) configurations were induced in five patients Ventricular fibrillation was induced in two patients during the electrophysiologic study (EPS) Five patients had very high pacing threshold and/or ineffective pacing in one or many regions of the right ventricle Two members of one family died suddenly One member was a dwarf with ARVC Spontaneous VT with a left bundle branch block (LBBB) configuration was recorded in five patients, polymorphic VT with extremely short coupling interval in one, and premature ventricular complexes with LBBB configuration in 12 (six patients) Conclusion Our familial study strongly suggests that ARVC may be a hereditary disease and it is helpful in the diagnosis and detection of ARVC The most common manifestations were abnormal structure and function of the right ventricle and abnormal ECG of repolarization and ventricular arrhythmia which originates from the right ventricle

Is right ventricular mid-septal pacing superior to apical pacing in patients with high degree atrio-ventricular block and moderately depressed left ventricular function?

Objective： We are aimed to investigate whether right ventricular mid-septal pacing （RVMSP） is superior to conventional right ventricular apical pacing （RVAP） in improving clinical functional capacity and left ventricular ejection fraction （LVEF） for patients with high-degree atrio-ventricular block and moderately depressed left ventricle （LV） function. Methods： Ninety-two patients with high-degree atrio-ventricular block and moderately reduced LVEF （ranging from 35% to 50%） were randomly allocated to RVMSP （n=45） and RVAP （n=47）. New York Heart Association （NYHA） functional class, echocardiographic LVEF, and distance during a 6-min walk test （6MWT） were determined at 18 months after pacemaker implantation. Serum levels of N-terminal pro-brain natriuretic peptide （NT-proBNP） were measured using an enzyme-linked immunosorbent assay （ELISA） kit. Results： Compared with baseline, NYHA functional class remained unchanged at 18 months, distance during 6MVVT （485 m vs. 517 m） and LVEF （36.7% vs. 41.8%） were increased, but BNP levels were reduced （2352 pg/ml vs. 710 pg/ml） in the RVMSP group compared with those in the RVAP group, especially in patients with LVEF 35%-40% （for all comparisons, P〈0.05）. However, clinical function capacity and LV function measurements were not significantly changed in patients with RVAP, despite the pacing measurements being similar in both groups, such as R-wave amplitude and capture threshold. Conclusions： RVMSP provides a better clinical utility, compared with RVAP, in patients with high-degree atrioventricular block and moderately depressed LV function whose LVEF levels ranged from 35% to 40%.

L-type calcium current in right ventricular outflow tract myocytes of rabbit heart

The mechanism of idiopathic ventricular tachycardia originating from the right ventricular outflow tract （RVOT） is not clear. Many clinical reports have suggested a mechanism of triggered activity. However, there are few studies investigating this be- cause of the technical difficulties associated with examining this theory. The L-type calcium current （/Ca-L）, an important in- ward current of the action potential （AP）, plays an important role in arrhythmogenesis. The aim of this study was to explore differences in the APs of right ventricular （RV） and RVOT cardiomyocytes, and differences in electrophysiological character- istics of the ICa-L in these myocytes. Rabbit RVOT and RV myocytes were isolated and their AP and Ic,-L were investigated us- ing the patch-clamp technique. RVOT cardiomyocytes had a wider range of AP duration （APD） than RV cardiomyocytes, with some markedly prolonged APDs and markedly shortened APDs. The markedly shortened APDs in RVOT myocytes were abolished by treatment with 4-AP, an inhibitor of the transient outward potassium current, but the markedly prolonged APDs remained, with some myocytes with a long AP plateau not repolarizing to resting potential. In addition, early afterdepolariza- tion （EAD） and second plateau responses were seen in RVOT myocytes but not in RV myocytes. RVOT myocytes had a high- er current density for/Ca-L than RV myocytes （RVOT （13.16±0.87） pA pF-1, RV （8.59±1.97） pA pF-1; P〈0.05）. The ICa-L and the prolonged APD were reduced, and the EAD and second plateau response disappeared, after treatment with nifedipine （10 μmol L^-1）, which blocks the Ica-L. In conclusion, there was a wider range of APDs in RVOT myocytes than in RV myocytes, which is one of the basic factors involved in arrhythmogenesis. The higher current density for ICa-L is one of the factors causing prolongation of the APD in RVOT myocytes. The combination of EAD with prolonged APD may be one of the mechanisms of RVOT-VT generation.

Kirschner wire migration from the right second rib to the right ventricle： a case report

Migrations of orthopedic wires to car- diovascular system are uncommon and rarely reported. We report a case of right ventricle embolization with the Kirschner wire that was used for right 2nd rib osteosynthesis 2 years and 8 months previously in a 50-year-old man. The patient was asymptomatic and migration of the Kirschner wire was discovered by routine chest X-ray. An 8 cm-long Kirschner wire was successfully retrieved from the right ventricle. The treatment strategy for Kirschner wire removal from right ventricle is discussed.