中英双语解读心房颤动房颤Atrial fibrillation.docx

中英双语解读心房颤动房颤Atrial fibrillation.docx

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中英双语解读心房颤动房颤Atrialfibrillation

心房颤动房颤Atrialfibrillation

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%。

Overview

Atrialisafibrillationnirregularandoftenrapidheartratethatcanincreaseyourriskofstrokes,heartfailureandotherheart-relatedcomplications.

Duringatrialfibrillation,theheart'stwoupperchambers（theatria）beatchaoticallyandirregularly—outofcoordinationwiththetwolowerchambers（theventricles）oftheheart.Atrialfibrillationsymptomsoftenincludeheartpalpitations,shortnessofbreathandweakness.

Episodesofatrialfibrillationmaycomeandgo,oryoumaydevelopatrialfibrillationthatdoesn'tgoawayandmayrequiretreatment.Althoughatrialfibrillationitselfusuallyisn'tlife-threatening,itisaseriousmedicalconditionthatsometimesrequiresemergencytreatment.

Amajorconcernwithatrialfibrillationisthepotentialtodevelopbloodclotswithintheupperchambersoftheheart.Thesebloodclotsformingintheheartmaycirculatetootherorgansandleadtoblockedbloodflow（ischemia）.

Treatmentsforatrialfibrillationmayincludemedicationsandotherinterventionstotrytoaltertheheart'selectricalsystem.

Symptoms

Somepeoplewithatrialfibrillationhavenosymptomsandareunawareoftheirconditionuntilit'sdiscoveredduringaphysicalexamination.Thosewhodohaveatrialfibrillationsymptomsmayexperiencesignsandsymptomssuchas:

Palpitations,whicharesensationsofaracing,uncomfortable,irregularheartbeatoraflip-floppinginyourchest

Weakness

Reducedabilitytoexercise

Fatigue

Lightheadedness

Dizziness

Shortnessofbreath

Chestpain

Atrialfibrillationmaybe:

Occasional. Inthiscaseit'scalledparoxysmal（par-ok-SIZ-mul）atrialfibrillation.Youmayhavesymptomsthatcomeandgo,usuallylastingforafewminutestohours.Sometimessymptomsoccurforaslongasaweekandepisodescanhappenrepeatedly.Yoursymptomsmightgoawayontheirownoryoumayneedtreatment.

Persistent. Withthistypeofatrialfibrillation,yourheartrhythmdoesn'tgobacktonormalonitsown.Ifyouhavepersistentatrialfibrillation,you'llneedtreatmentsuchasanelectricalshockormedicationsinordertorestoreyourheartrhythm.

Long-standingpersistent. Thistypeofatrialfibrillationiscontinuousandlastslongerthan12months.

Permanent. Inthistypeofatrialfibrillation,theabnormalheartrhythmcan'tberestored.You'llhaveatrialfibrillationpermanently,andyou'lloftenrequiremedicationstocontrolyourheartrateandtopreventbloodclots.

Whentoseeadoctor

Ifyouhaveanysymptomsofatrialfibrillation,makeanappointmentwithyourdoctor.Yourdoctormayorderanelectrocardiogramtodetermineifyoursymptomsarerelatedtoatrialfibrillationoranotherheartrhythmdisorder（arrhythmia）.

Ifyouhavechestpain,seekemergencymedicalassistanceimmediately.Chestpaincouldsignalthatyou'rehavingaheartattack.

病因

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。

Causes

Atrialfibrillationisanirregularandoftenrapidheartratethatoccurswhenthetwoupperchambersofyourheartexperiencechaoticelectricalsignals.Theresultisafastandirregularheartrhythm.Theheartrateinatrialfibrillationmayrangefrom100to175beatsaminute.Thenormalrangeforaheartrateis60to100beatsaminute.

Yourheartismadeupoffourchambers—twoupperchambers（atria）andtwolowerchambers（ventricles）.Withintheupperrightchamberofyourheart（rightatrium）isagroupofcellscalledthesinusnode.Thisisyourheart'snaturalpacemaker.Thesinusnodeproducesthesignalthatnormallystartseachheartbeat.

Normally,thesignaltravelsthroughthetwoupperheartchambers,andthenthroughaconnectingpathwaybetweentheupperandlowerchamberscalledtheatrioventricular（AV）node.Themovementofthesignalcausesyourhearttosqueeze（contract）,sendingbloodtoyourheartandbody.

Inatrialfibrillation,thesignalsintheupperchambersofyourheartarechaotic.Asaresult,theyquiver.TheAVnode—theelectricalconnectionbetweentheatriaandtheventricles—isbombardedwithimpulsestryingtogetthroughtotheventricles.

Theventriclesalsobeatrapidly,butnotasrapidlyastheatria,asnotalltheimpulsesgetthrough.

Possiblecausesofatrialfibrillation

Abnormalitiesordamagetotheheart'sstructurearethemostcommoncauseofatrialfibrillation.Possiblecausesofatrialfibrillationinclude:

Highbloodpressure

Heartattack

Coronaryarterydisease

Abnormalheartvalves

Heartdefectsyou'rebornwith（congenital）

Anoveractivethyroidglandorothermetabolicimbalance

Exposuretostimulants,suchasmedications,caffeine,tobaccooralcohol

Sicksinussyndrome—improperfunctioningoftheheart'snaturalpacemaker

Lungdiseases

Previousheartsurgery

Viralinfections

Stressduetosurgery,pneumoniaorotherillnesses

Sleepapnea

However,somepeoplewhohaveatrialfibrillationdon'thaveanyheartdefectsordamage,aconditioncalledloneatrialfibrillation.Inloneatrialfibrillation,thecauseisoftenunclear,andseriouscomplicationsarerare.

Atrialflutter

Atrialflutterissimilartoatrialfibrillation,buttherhythminyouratriaismoreorganizedandlesschaoticthantheabnormalpatternscommonwithatrialfibrillation.Sometimesyoumayhaveatrialflutterthatdevelopsintoatrialfibrillationandviceversa.

Theriskfactorsforandthesymptomsandcausesofatrialflutteraresimilartothoseofatrialfibrillation.Forexample,strokesarealsoaconcerninsomeonewithatrialflutter.Aswithatrialfibrillation,atrialflutterisusuallynotlife-threateningwhenit'sproperlytreated.

Riskfactors

Certainfactorsmayincreaseyourriskofdevelopingatrialfibrillation.

Theseinclude:

Age. Theolderyouare,thegreateryourriskofdevelopingatrialfibrillation.

Heartdisease. Anyonewithheartdisease—suchasheartvalveproblems,congenitalheartdisease,congestiveheartfailure,coronaryarterydisease,orahistoryofheartattackorheartsurgery—hasanincreasedriskofatrialfibrillation.

Highbloodpressure. Havinghighbloodpressure,especiallyifit'snotwell-controlledwithlifestylechangesormedications,canincreaseyourriskofatrialfibrillation.

Otherchronicconditions. Peoplewithcertainchronicconditionssuchasthyroidproblems,sleepapnea,metabolicsyndrome,diabetes,chronickidneydiseaseorlungdiseasehaveanincreasedriskofatrialfibrillation.

Drinkingalcohol. Forsomepeople,drinkingalcoholcantriggeranepisodeofatrialfibrillation.Bingedrinkingmayputyouatanevenhigherrisk.

Obesity. Peoplewhoareobeseareathigherriskofdevelopingatrialfibrillation.

Familyhistory. Anincreasedriskofatrialfibrillationispresentinsomefamilies.

Complications

Sometimesatrialfibrillationcanleadtothefollowingcomplications:

Stroke. Inatrialfibrillation,thechaoticrhythmmaycausebloodtopoolinyourheart'supperchambers（atria）andformclots.Ifabloodclotforms,itcoulddislodgefromyourheartandtraveltoyourbrain.Thereitmightblockbloodflow,causingastroke.

Theriskofastrokeinatrialfibrillationdependsonyourage（youhaveahigherriskasyouage）andonwhetheryouhavehighbloodpressure,diabetes,ahistoryofheartfailureorapreviousstroke,andotherfactors.Certainmedications,suchasbloodthinners,cangreatlyloweryourriskofastrokeorthedamagetootherorganscausedbybloodclots.

Heartfailure. Atrialfibrillation,especiallyifnotcontrolled,mayweakentheheartandleadtoheartfailure—aconditioninwhichyourheartcan'tcirculateenoughbloodtomeetyourbody'sneeds.

Prevention

Topreventatrialfibrillation,it'simportanttoliveaheart-healthylifestyletoreduceyourriskofheartdisease.Ahealthylifestylemayinclude:

Eatingaheart-healthydiet

Increasingyourphysicalactivity

Avoidingsmoking

Maintainingahealthyweight

Limitingoravoidingcaffeineandalcohol

Reducingstress,asintensestressandangercancauseheartrhythmproblems

Usingover-the-countermedicationswithcaution,assomecoldandcoughmedicationscontainstimulantsthatmaytriggerarapidheartbeat