2010年4月30日星期五

心律過慢的疑慮

 
心律過慢的疑慮

09年的七月至十月期間 , 我到醫院處作心臟檢查 , 做過跑步機測試 , 超音波掃瞄 , 結果是一切正常 , 但其後攜帶了一次24小時心跳記錄儀 , 及做心電圖 , 醫生說心跳得很慢 , 最低只有35次 , 有可能係heart block , 要求我植入心臟起搏器 , 但我不覺有什麼異樣 , 只間中有點頭暈及呼吸困難 , 透不過氣 , 但已很久沒有發生了。

其實我在04年間也在香港做了相似的心臟檢查 , 情況恐比現時嚴重 , 頭暈次數頻密 , 並感到有點飄飄然( high ) 的感覺 , 心跳也間中停頓一兩下 , 那時的主任醫生說:「這情形在香港很普遍 , 可以說在街上行的人 , 十個人之中差不多有五個都或多或少是這樣的 , 應沒有大礙。」

我就以上的情況在互聯網上將自己的疑慮請教了專科醫生 , 為何會有不同的結論 , 而我是極度抗拒做這個手術 , 除了心理因素外 , 更重要是裝置後要多方面留意 , 況且把一件外來物裝在體內也覺得突兀 , 而電池耗盡時還要把它取出 , 換上另外一個起搏器 , 雖說是小手術 , 但心裡總感到不安 , 駭人及害怕 …… 問題是否如不做手術 , 有何後果 ? 或不久後心跳會否回復正常 ? 可有藥物治療 ? 而究竟多少次心跳才是最起碼的安全系數 ? 當植入後心臟會有什麼感覺 ?

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以下是醫生的回覆

心律不齊是一個很闊的題目,但簡單來說,可以分為心律過速,心律過慢和心律時快時慢三大類,其中又分為有規律性和不規則性,以及間歇性和持續性幾大類。

心跳過慢有很多成因,包括甲狀腺分泌不足、藥物影響、經常運動、房竇病變、隱性心房早搏、房室傳導阻滯(二期或三期)等,但正常人有時心跳也會少於每分鐘60次,特別是在熟睡時,心跳可以放緩至每分鐘30-40次。正常情況下,日間心跳最起碼每分鐘45次以上。心跳過慢最常見的症狀是頭暈眼花、容易氣喘、疲倦、心跳很重等,若患有冠心病的,也會出現心絞痛的症狀。

由於心律過慢成因眾多,治療方法也要對症下藥。一般來說,心臟起搏器只適用於第二期或第三期房室傳導阻滯、房竇病變或心竇暫停跳動超過3.5秒以上等情況。它只是作輔助心跳之用,防止因心跳過慢而出現各種症狀,並不是治本的方法,亦沒有藥物治療使其心律回復正常。植入心臟起搏器是一項手術,需要局部麻醉和在肩膀附近開一個1-2吋的傷口,從大靜脈中伸入電線至右心房和心室,當中涉及一定的風險,但這風險在現今的技術來說是十分低。由於有當中涉及一定的風險,醫生在選擇治療時都會很小心,確保有確實需要才會建議做心臟起搏器之手術。

手術後,病人多可以回復正常生活,不會有太大不便和不舒服。病人在適應期過後,一般都不會察覺起搏器的存在,亦不會出現排斥的現象。唯一的是要定期檢查,以確保起搏器運作正常和電力充足。


Translation from Chinese to English:

Cardiac arrhythmia is a very broad subject, but simply, can be divided into rhythm too fast, too slow and irregular heart rate when the fast slowly three categories, which are divided into a regularity and irregular, as well as intermittent and sustained for several major categories.

There are many causes of slow heart rate, including the lack of thyroid secretion, the influence of drugs, regular exercise, the Housing sinus disease, recessive atrial premature beats, atrioventricular conduction block (2 or 3), etc., but the heartbeat will be normal sometimes less than 60 times per minute, especially in the sleeping, the heartbeat can be moderated to 30-40 times per minute. Under normal circumstances, at least during the day heart rate for more than 45 times per minute. Bradycardia of the most common symptoms are dizziness, easy to asthma, fatigue, heart heavy, etc., if suffering from coronary heart disease, and will also appear angina symptoms.

As the heart rate is too slow due to many causes, treatment methods should prescribe the right medicine. In general, cardiac pacemakers only apply to the second or third block Forward House chamber, the Housing sinus pause sinus disease or heart beat more than 3.5 seconds or more and so on. It is only used as auxiliary heart, prevent heart beat too slowly and the emergence of various symptoms, not solve the problem and no medication can heal. Implantable cardiac pacemaker is an operation, I need local anesthesia and in the vicinity of the shoulder to open a 1-2 inch wound, stretching wires from large vein to the right atrium and ventricle, which involves certain risks, but risks Today's technology is very low. Because of certain risks involved, the doctors in the choice of treatment will be very careful to ensure that there is a genuine need for the suggestion of a heart pacemaker surgery.
After surgery, the patient can return to normal life over there will not be too great an inconvenience and discomfort. Patients after the adaptation period, are generally not aware of the existence of pacemakers, but also does not appear the phenomenon of exclusion. The only thing is to regular checks to ensure normal functioning of pacemakers and electricity sufficient.



發佈於2010年4月30日上午10:28
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