老年人心瓣膜病合并房颤及心衰的处理原则.pptVIP

老年人心瓣膜病合并房颤及心衰的处理原则;随着人口的老龄化,老年退行性钙化性瓣膜病逐渐占有重要的地位,是目前老年人的特殊疾病。

已经成为老年人心力衰竭、心律失常、晕厥、猝死的原因之一。

对冠心病具有重要预测价值;;;国外报道的发病率明显高于国内。Pomerance等尸检162例死于心衰的患者,分析其原因后发现钙化性瓣膜病变占45%,仅次于冠心病。

Wong等在78例65～102岁的患者中

发现瓣膜退行性改变占74%。

90～100岁年龄组几近100%

Springer.Verlag,1982:63～67.

.JAMGeriatirsoc,1983,3l:156.;;;Mitralstenosiswasfoundin23cases(6.4%),ofwhich21caseswererheumaticandtheremaining2weremitralringcalcification(MRC).Mitralregurgitationwasobservedin126cases(35.3%):69ofpapillarymuscledysfunction,26ofmitralvalveprolapse(MVP),16ofMRC,9ofrupturedchordaetendineae,3ofrheumaticand3ofcongenital.

JpnCircJ.1982Apr;46(4):337-45;Aorticstenosiswasnotedin33cases(9.2%):27ofcalcified,5ofrheumaticandoneofcongenital.Aorticregurgitationwasfoundin169cases(47.2%):112ofdegenerative,47ofsyphilitic,7ofrheumaticand2ofaortitissyndrome.Therewere6cases(1.7%)oftricuspidregurgitation.

JpnCircJ.1982Apr;46(4):337-45;Etiologicalclassificationrevealed6cases(1.7%)ofcongenital,36(10%)ofrheumatic,49(13.7%)ofsyphilitic,27(7.5%)ofMVP,69(19.3%)ofischemicand166(46.4%)ofdegenerativevalvulardisease.

JpnCircJ.1982Apr;46(4):337-45

;Atotalof458cases(11.5%)withvalvularheartdiseasesintheaged(greaterthanorequalto60years)werefoundamong4,000consecutiveautopsies.Theyincluded204cases(45%)ofaorticregurgitation(AR),171cases(37%)ofmitralregurgitation(MR),followedby45(10%)ofaorticstenosis(AS)and27cases(6%)ofmitralstenosis(MS).

JCardiolSuppl.1988;19:29-38.;;;;仍关注对老年人风心病;;;;ANovelRoleoftheSympatho-AdrenergicSysteminRegulatingValveCalcification;;老年瓣膜病合并房颤;老年瓣膜病合并房颤;;;;首先老年瓣膜病合并冠心病、高血压者居多,其次为糖尿病,表明动脉粥样硬化的易患因素如高血压、高胆固醇、高血糖也是导致瓣膜钙化的重要因素。因此老年人应尽早防治各种引起动脉硬化的因素,这样可能延缓退行性心瓣膜病的发生,从而???少各类心律失常的发生,降低死亡率;其次此症除与心房肌缺血有关外,一个主要

因素是心房肌的退行性变,这与瓣膜的退行

性病变是一致的。一些心房纤颤,部分快速

性心房纤颤经治疗转复窦律后伴有T波倒置

外