AF – atrial fibrillation
cardiomegaly – n. 心脏扩大
rheumatic – a. 风湿性的
fibrillation – n. 颤动
per se – ad. 本身，本质上
kick – n. 踢，反冲
auricle – n. 心耳
stagnant – a. 不流动的，停滞的
conversion – n. 倒转，转复，转换
ibutilide – n. 伊布利特
quinidine – n. 奎尼丁
electrocardioversion – n. 心电复律
current shock – 电击
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Understanding Atrial Fibrillation 心房颤动
AF is a relatively common arrhythmia of the atria. It has been associated with coronary artery disease, myocardial inflammation, valvular disease, cardiomegaly, and rheumatic heart disease.
房颤是一种相对常见的心房心律不齐，它与冠状动脉疾病、心肌炎症、瓣膜疾病、心脏扩大和风湿性心脏疾病相关联。
Fibrillation results in lack of any coordinated pumping action, because the muscles are not stimulated to contract and pump out blood. In the ventricles, this is a life-threatening situation. If the ventricles do not pump blood, no blood is delivered to the brain, the tissues of the body, or the heart muscle itself. However, loss of pumping action in the atria per se does not usually cause much of a problem. The atrial contraction is like an extra kick of blood into the ventricles; it provides a nice backup to the system, but the blood will still flow normally without that kick.
One of the problems with AF occurs when it exists for longer than 1 week. The auricles fill with blood that is not effectively pumped into the ventricles. Over time, this somewhat stagnant blood tends to clot. Because the auricles are sacks of striated muscle fibers, blood clots form around these fibers. In this situation, if the atria were to contract in a coordinated manner, there is a substantial risk that those clots or emboli would be pumped into the ventricles and then into the lungs (from the right auricle), which could lead to pulmonary emboli, or to the brain or periphery (from the left auricle), which could cause a stroke or occlusion of peripheral vessels.
Treatment of AF can be complicated if the length of time the patient has been in AF is not known. If a patient goes into AF acutely, drug therapy is available for rapid conversion. For example, ibutilide is often very effective when given IV for rapid conversion of the AF. IM quinidine also may convert AF effectively. In some situations, digoxin has been effective in converting AF. Electrocardioversion, a DC current shock to the chest, may break the cycle of fibrillation and convert a patient to sinus rhythm, after which the rhythm will need to be stabilized with drug therapy. Quinidine is often the drug of choice for long-term stabilization.
1. Which of the following drugs can cause severe hematologic disorders?
A. Digoxin (Lanoxin).
B. Quinidine (Cardioquin).
C. Disopyramide (Norpace).
D. Procainamide (Pronestyl). 2. Which of the following ECG findings alerts the nurse that the client needs an antiarrhythmic?
A. Normal sinus rhythm.
B. Sinus bradycardia.
C. Sinus arrhythmia.
D. Frequent ventricular ectopy.
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答案 Answer 1. D. Procainamide (Pronestyl). Rationale: Pronestyl is known for this serious side effect. Associate Pronestyl with plasma — P and P. This drug is known for its hematologic side effects. Procainamide is known to cause certain blood dyscrasias. Procainamide as been known to cause bone marrow toxicity, leading to pancytopenia or agranulocytosis; this is usually due to hypersensitivity or varied immunologic mechanisms 2. D. Frequent ventricular ectopy. Rationale: Ventricular ectopy can be a life-threatening arrhythmia; therefore, the client needs an arrhythmic. Frequent ventricular ectopy is a common clinical presentation in patients suffering idiopathic ventricular outflow tract arrhythmias. These are focal arrhythmias that generally occur in patients without structural heart disease and share a predilection for characteristic anatomic sites of origin Other choices are not arrhythmias that need to be treated.
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