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#19
16.04.2010, 09:22
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Насчет апноэ мне ничего неизвестно. Известно, что профессиональная спортсменка.
Повторяю вопрос: "В отсутствие явной АВ блокады и симптомов (не было жалоб никаких) ЭКС был ли нужен в данной ситуации согласно EBM-м правилам?"  
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#21
16.04.2010, 09:32
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Цитата:
Эпилепсии-то, я так понимаю, у неё тоже явной нет?
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#23
16.04.2010, 10:15
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A young asymptomatic male athlete came to our laboratory to be enrolled in a research protocol on physical fatigue. Routine clinical and cardiological evaluations including echocardiogram were in the normal range. Several consecutive cardiopulmonary tests showed a fairly good tolerance to exercise, with no symptoms even when the effort was abruptly arrested. On the other hand, Holter ECG recordings showed long nocturnal sinus pauses. As he was absolutely asymptomatic and free from any structural heart disease, he underwent a follow-up with repeated Holter monitorings for one year. During this period he decided on his own to stop practising sports; in spite of this sharp reduction in his overall physical activity, consecutive Holter monitorings showed that the sinus pauses were progressively increasing in duration (up to 9.2 seconds). With the hypothesis of a malignant vagotonia, he underwent a tilt test; however, we could not elicit any pauses or symptoms. The pauses grew longer over time; a endocavitary electrophysiologic test was performed, which showed no evidence of disease. To rule out the hypothesis of a sleep apnoea syndrome, he also underwent a polysomnography, including EEG, eye movement electromyography, arterial blood oxygen saturation and thoracic impedance: no alterations were detected with the exception of the sinus pauses, which appeared to be strictly linked to REM sleep, as suggested by the concurrent increase in rapid eye movements and desynchronized EEG. We hence made a diagnosis of sinus arrest during REM sleep (SAdRS), a very uncommon disease belonging to the parasomnias. Pauses were then quantified for one month by implanting a ECG loop recorder. As the patient became more and more upset and worried, and the pauses increased to nearly 12 seconds, we decided to implant a pacemaker, which is the only therapeutic option established in the literature for patients with SAdRS.
PMID: 15346235 [PubMed - indexed for MEDLINE]
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#24
16.04.2010, 13:51
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Итак, вопрос имплантации ЭКС должен решаться индивидуально.
ЧПЭС=точка Венкебаха 100; ВВФСУ 4800мс; КВВФСУ 3880 мс. После атропина точка Венкебаха 150; ВВФСУ 1120мс; КВВФСУ 200мс. Спасибо за обсуждение.
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#25
16.04.2010, 14:45
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Цитата:
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#26
14.05.2010, 10:38
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(восхищенно) Вот это вагус так вагус!
 По тактике - думаю ЭКС тут необходим ("не дожидаясь перитонита!" (с)) Насчет "отсутствия" симптомов - это оччень большой вопрос, спит же, вот и не улавливаются синкопы на фоне сна... Или надо ждать пока не обмочится?
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#27
14.05.2010, 18:10
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ЭКС ей имплантировали с порогом ЧСС 30 уд/мин. Через 1г. и 4 месяца стала уставать, сонливость, но при объективном сравнении разницы в работоспособности нет. Перепрограммировали на 50 уд/мин. Самочувствие нормализовалось. Но отмечает ускоренное сердцебиение в покое
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#28
15.05.2010, 10:21
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Цитата:
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Линейный вид
