心房颤动的流行病学现状及危害

心房颤动是最为常见的心律失常,在总人口中占有不到1%的比例.其流行与年龄及临床心血管疾病的增加有密切关系.充血性心力衰竭、心脏瓣膜病、左心房增大、高血压病、脑卒中及高龄都与心房颤动的流行独立相关.多项研究已经表明,心房颤动与卒中、充血性心力衰竭及全因死亡率有关.近期,越来越多的研究证明心房颤动对认知功能也有一定的影响.     

慢性充血性心力衰竭合并贫血、铁缺乏的研究进展

近年来由于心血管疾病发病率的不断上升,使得慢性充血性心力衰竭发病率也不断升高。最近的研究发现在慢性充血性心力衰竭患者中,有很大比例患者合并铁缺乏或贫血,且二者与慢性充血性心力衰竭预后密切相关。本文就慢性充血性心力衰竭患者与贫血及铁缺乏的相关性,以及慢性充血性心力衰竭合并贫血及铁缺乏的可能发生机制、治疗进展作一概述和总结。     

心房颤动的病因、发病机制与射频导管消融治疗现状

随着人们研究的不断深入,对心房颤动的病因、发病机制有了更新的认识。后者从起搏点兴奋性增高,折返机制,发展到对心肌袖、电重构的认识;以及肺静脉、迷走神经在阵发性心房颤动中的作用,遗传物质异质性及基因突变等。同样,心房颤动的射频导管消融治疗也取得了突破性的进展。     

心房颤动的病因、发病机制与射频导管消融治疗现状

随着人们研究的不断深入,对心房颤动的病因、发病机制有了更新的认识.后者从起搏点兴奋性增高,折返机制,发展到对心肌袖、电重构的认识;以及肺静脉、迷走神经在阵发性心房颤动中的作用,遗传物质异质性及基因突变等.同样,心房颤动的射频导管消融治疗也取得了突破性的进展.     

奥伦自理理论对充血性心力衰竭患者综合生存质量的预后影响研究

研究分析奥伦自理理论对充血性心力衰竭患者综合生存质量的预后影响。选取2012年2月~2013年5月本院收治的90例充血性心力衰竭患者为研究对象,将90例患者遵循随机分配的原则分为对照组（常规护理干预组）45例和观察组（奥伦自理理论组）45例,然后将两组患者护理干预前和护理干预后1个月、3个月的MLHFQ量表、WHOQOL-100量表及Zung量表评估结果进行统计与比较。观察组护理干预后1个月、3个月的MLHFQ量表评分均低于对照组,WHOQOL-100量表评分高于对照组,Zung量表评分与阳性率均低于对照组,P均〈0.05,两组护理干预后的评估结果差异均有统计学意义。奥伦自理理论有助于改善充血性心力衰竭患者的综合生存质量,在此类患者中的应用价值较高。     

慢性心房颤动的导管消融治疗:依然任重道远

心房颤动,作为心律失常领域皇冠上的明珠,一直以来成为研究的热点.自从1998年Haissaguerre教授率先发现肺静脉与心房颤动的密切关系之后,心房颤动的导管消融治疗取得了突飞猛进的发展.进而,这一重要的临床进展反向地助推了心房颤动发生机制的研究进展.     

慢性心房颤动的导管消融治疗：依然任重道远

心房颤动,作为心律失常领域皇冠上的明珠,一直以来成为研究的热点。自从1998年Haissaguerre教授率先发现肺静脉与心房颤动的密切关系之后,心房颤动的导管消融治疗取得了突飞猛进的发展。进而,这一重要的临床进展反向地助推了心房颤动发生机制的研究进展。目前,导管消融治疗房颤领域许多难题被攻克,许多认识极大地得到了提高...     

房颤的外科消融治疗进展

外科消融是治疗心房颤动(房颤)的重要手段,尤其是对于合并其他心脏疾病需要进行其他心脏手术的患者。目前房颤外科消融策略主要包括经典迷宫手术、改良迷宫手术、微创房颤消融及杂交手术等,其中以微创外科消融和其他心脏手术同期进行的改良迷宫手术最为流行,杂交手术尚处初始阶段,具有广阔的发展前景。本文主要就房颤外科消融的适应证、策略进行讨论。     

登革热的流行特点及治疗

登革热现已成为一个世界性的严重公共卫生问题。目前它广泛流行于热带及亚热带地区。登革病毒可引起隐性感染、典型登革热、登革出血热及登革休克综合征等临床类型。随着我国对外交往不断增多,输入性登革热病例也越来越多,因而我们有必要了解该病的流行特点、临床表现、诊断、治疗及控制措施。     

登革热的流行特点及治疗

登革热现已成为一个世界性的严重公共卫生问题.目前它广泛流行于热带及亚热带地区.登革病毒可引起隐性感染、典型登革热、登革出血热及登革休克综合征等临床类型.随着我国对外交往不断增多,输入性登革热病例也越来越多,因而我们有必要了解该病的流行特点、临床表现、诊断、治疗及控制措施.     

The Effect of Non-Stroke Cardiovascular Disease States on Risk for Cognitive Decline and Dementia: A Systematic and Meta-Analytic Review

Cardiovascular disease is associated with increased risk for cognitive decline and dementia, but it is unclear whether this risk varies across disease states or occurs in the absence of symptomatic stroke. To examine the evidence of increased risk for cognitive decline and dementia following non-stroke cardiovascular disease we conducted two independent meta-analyses in accordance with PRISMA guidelines. The first review examined cardiovascular diagnoses (atrial fibrillation, congestive heart failure, periphery artery disease and myocardial infarction) while the second review assessed the impact of atherosclerotic burden (as indicated by degree of stenosis, calcification score, plaque morphology or number of plaques). Studies eligible for review longitudinally assessed risk for clinically significant cognitive decline and/or dementia and excluded stroke and cognitive impairment at baseline. Summary statistics were computed via the inverse variance weighted method, utilising Cox Proportional Hazards data (Hazard Ratios, HR). Both atrial fibrillation (n = 5, HR = 1.26, 95% CI [1.12, 1.43]) and severe atherosclerosis (n = 4, HR = 1.59, 95% CI [1.12, 2.26]) emerged as significant risk factors for cognitive decline and/or dementia. A small set of studies reviewed, insufficient for meta-analysis, examining congestive heart failure, peripheral artery disease and myocardial infarction suggested that these conditions may also be associated with an increased risk of cognitive decline/dementia. In the absence of stroke, patients with atrial fibrillation or generalised atherosclerosis are at heightened risk for cognitive deterioration. Nonetheless, this paper highlights the need for methodologically rigorous and prospective investigation of the relationship between CVD and dementia.     

Relation between cardiovascular and metabolic disease and cognition in very old age: cross-sectional and longitudinal findings from the berlin aging study.

This study documented findings on the relation between cognitive functioning (perceptual speed, memory, fluency, and knowledge) and cardiovascular and metabolic disease in a sample of very old adults (ages 70 and older), both cross-sectionally (n=516) and longitudinally (n=206) in a 4-year follow-up. After age, SES, sex, and dementia status were controlled for, 4 diagnoses were negatively associated with cognition: congestive heart failure, stroke, coronary heart disease, and diabetes mellitus, with a joint effect of 0.47 standard deviations. The impact of disease status was largest on perceptual speed and fluency, memory was impacted only by diabetes, and knowledge was not related to any somatic diagnosis. There was no differential decline in participants diagnosed with 1 of these 4 diseases and those who were not. The only cardiovascular risk factor associated with cognitive performance was alcohol consumption.     

Retraction Note: Globalization and vulnerable populations in times of a pandemic: A Mayan perspective

Understanding representations of disease in various art genres provides insights into how patients and health care providers view the diseases. It can also be used to enhance patient care and stimulate patient self-management. This paper reviews how cardiovascular diseases are represented in novels, films, and paintings: myocardial infarction, aneurysm, hypertension, stroke, heart transplantation, Marfan’s disease, congestive heart failure. Various search systems and definitions were used to help identify sources of representations of different cardiovascular diseases. The representations of the different diseases were considered separately. The Common Sense Model was used a theoretical model to outline illness perceptions and self-management in the various identified novels, films, and paintings. Myocardial infarction followed by stroke were the most frequently detailed diseases in all three art genres. This reflects their higher prevalence. Representations ranged from biomedical details through to social and psychological consequences of the diseases. Artistic representations of cardiovascular diseases reflect cognitions, emotions, and images of prevalent disease. These representations shape views and behaviour of ill and healthy persons regarding heart diseases. As these representations are amenable to change, they deserve further research, which may be instrumental in improving the quality of life of persons struck by cardiovascular diseases. Changing illness perceptions appears to be a method to improve self-management and thereby quality of life in patients with various cardiovascular diseases.     

心房颤动病因诊断的误区

心房颤动是临床上最常见的快速性心律失常,发病率很高,我国为0．77％,估计有1000万患者。房颤的病因众多,包括冠心痛、高血压、风湿性心脏病、心肌病、肺栓塞等,在病因诊断中存在一些误区。本文将这些误区大致归纳为3个方面,并分别进行讲述。     

心律失常发生的别差异

临盘床中某些心律失常的发生具有性别差异。女性同男性相比,其平均静息心率快,QT间期长,QRS波群时间短,QRS电压低。女性有更高的病态窦房结综合征、不适当性窦性心动过速、房室结折返性心动过速、右室特发性室速和长QT间期综合征引起的心律失常事件的发生率。而男性房室传导阻滞、颈动脉窦综合征、房颤、旁路导致的室上性心动过速、预激综合征、室颤、猝死、Brugada综合征和触发型室速的发生率高。这些差异有的与心律失常伴发的器质性心脏病男女发生率不同有关,另外性激素对离子通道的功能、表达的影响以及自主神经张力的差异在这些差异的产生中也具有重要作用。了解这些差异对女性心律失常处理具有重要的指导作用。     

Caregiver Social Problem Solving Abilities and Family Member Adjustment Following Congestive Heart Failure

Family members have a considerable impact on the health and well-being of others in the family. The characteristics of family caregivers that relate to care recipients' positive and negative outcomes associated with chronic disease have received scant empirical attention. We reasoned that family caregiver social problem solving abilities would be associated with depression and life satisfaction reported by persons with congestive heart failure (CHF). Correlational analyses found that caregiver negative orientation toward solving problems was significantly predictive of higher depression and with decreased life satisfaction of persons with CHF. These findings indicate that family caregiver problem solving abilities are important factors in adjustment following CHF. Implications for clinical interventions and theoretical models of problem solving are discussed.     

Preliminary results of a pilot program on depression in patients with congestive heart failure

While the sample size is too small to warrant conclusions, these preliminary results suggest that assessment of depression would be worthwhile for patients diagnosed with congestive heart failure. 32 out of 54 patients with congestive heart failure scored positive for depression. When psychiatric treatment was given, there was a decrease in depressive symptoms for four of the six patients at the 6-mo, retest. A decrease in depressive symptoms was found for two of the six untreated patients, and the remaining four patients had worse scores on the Zung Depression Inventory. Primary care physicians, who typically meet with such patients regularly, are encouraged to screen for depression, as their clinical assessments in this study were associated with scores on the Zung Depression Inventory. These observations support a full scale investigation with a much larger sample size and a requisite medical cost comparison.     

Stroke risk factors

Despite advances in the treatment of acute cerebral infarction, the most effective method of reducing stroke morbidity and mortality is the identification and modification of stroke risk factors. Modifiable stroke risk factors include hypertension, atrial fibrillation, hypercholesterolemia, cigarette smoking, hyperhomocystinemia, and carotid stenosis. Improved identification of individuals at increased stroke risk due to these factors can reduce individual risk and the cost to society of the consequences of stroke.     

关注心房颤动的临床治疗决策

心房颤动发生率很高,我国为0．77％,估计有1000万患者。房颤分类为初发房颤、阵发性房颤、持续性房颤和永久性房颤。房颤病因众多,包括高血压病、心肌病、心衰、甲亢及冠心病等。房颤危害严重,房颤引发卒中高出5倍,房颤促进或加重心衰,房颤增加痴呆2倍。房颤增加病死率,严重降低患者生命质量。房颤治疗决策主要恢复正常窦性心律,并预防其复发和控制心室率与抗凝治疗预防血栓事件。