[SCD-FORUM] 4E: 给Dr. Cannom的问题 Miss Tink

[SCD Symposium]

1.     4E: 给Dr. Cannom的问题   Miss Tink


Cannom教授，您好！

感谢您提供的病例讨论


你提到了：“室性期前收缩……被运动所抑 
制”……“但是在中午他出现了一次发作，他的同事 
对他进行了CRP”

在接近8年的时间里，许多诊断为心律失常性右心室 
发育不良（ARVD）的患者，都提到他们的室性期前收 
缩在他们刚开始运动的时候就会“离开”。而其他的 
提到运动会诱发VT（例如，骑赛车，跆拳道等）

许多人提到，当他们出现VT甚至晕厥时，和他们在一 
起的人说他们像“癫痫”发作。

我的问题是：

1. 是不是已知，有频发室性期前收缩的患者是否知道 
在做一些让心率加快的运动时会发生猝死？

当ARVD患者的最低起搏点设定为65-85时（根据不同的患 
者）他们的病情会稳定（例如减少频发室性期前收缩 
以及短和/或长的室速）。

2. 如果知道了一些患者在做轻度活动时会出现频发的 
室性期前收缩，是不是有理由将这类患者最低起搏点 
设置为上述提到的？

3. 出现室速并晕厥的患者是否经常像癫痫发作一样？

4. 这个病例中的患者是否有癫痫的倾向？他有癫痫症 
吗？是否可能会将患者的发作认为是癫痫和晕厥，而 
没有癫痫症的依据，就怀疑是某些原因引起的室速？



感谢您能回答这些问题。



Micheline Tink  Long
International ARVD Family Network Group






Dr. Cannom,

Thank you for the case study...

You noted:
"PVC's...suppressed with exercise"..."but at noon he had a seizure  
and CPR was initiated by a colleague"

Over the course of nearly 8 years, numerous ARVD diagnosed  
people,group members, have mentioned that their PVCs "go away" when  
they begin to exercise a little.  Others have mentioned that exercise  
can take them quickly into VT (i.e. hopping on an exercise bicycle,  
doing a few
moves of Tae Kwon Do.)
Numerous members have mentioned that when they have had VT and  
subsequently fainted, that those who were with them said they  
appeared to be having a "seizure"

The questions are:
1.  Is it well known that some patients with frequent PVCs often  
notice that they go away during exercise of some sort, i.e. raise in  
heart rate?
As a note, a number of ARVD diagnosed group members have stabilized  
(i.e. frequent PVCs, short and/or long runs of VT are alleviated)  
when their Brady pacing is set to 65 - 85 (dependent on patient.)

2.  If it is known that frequent PVCs often disappear in some people  
during light exercise, is this the reason that some EPs set their  
patient's brady pacing as mentioned above?
3. Is it well known that patients who go into VT and subsequently  
pass out often appear to be having a seizure?
  4. Had the patient in this case been prone to seizures?  Do they  
have epilepsy?  Is it possible that a patient suffering that which is  
described as seizures and syncope, with no evidence of epilepsy, might
  be suspected of something known to cause VT?


  Thanks in advance for your help with these answers.

  Micheline Tink  Long
  International ARVD Family Network Group
--
Dr. Sergio Dubner
President of Scientific Committee

Dr. Edgardo Schapachnik
President of Steering Committee