Fogoros R N
Department of Medicine, Medical College of Pennsylvania, Pittsburgh.
Neurol Clin. 1993 May;11(2):375-90.
Cardiac arrhythmias are an important cause of neurologic symptoms. Bradyarrhythmias and tachyarrhythmias, by disrupting blood flow to the brain and causing cerebral hypoxia, can lead to loss of consciousness (and ultimately to cerebral necrosis or death). Thus cardiac arrhythmias must be considered as a potential cause in any patient presenting with syncope. For syncopal patients in whom the substrate for reentrant ventricular arrhythmias is found (that is, patients with ventricular dysfunction), management must be extremely aggressive because their near-term risk for sudden death is high, and conservative therapy is ineffective. Embolic stroke is a common result of atrial fibrillation. Several randomized trials now indicate that anticoagulation with low-dose warfarin is necessary, whenever possible, in patients with atrial fibrillation even in the absence of underlying valvular heart disease. Ongoing studies are evaluating the efficacy of aspirin in preventing embolic events.
心律失常是神经症状的一个重要原因。缓慢性心律失常和快速性心律失常通过扰乱脑部血流并导致脑缺氧，可导致意识丧失（最终导致脑坏死或死亡）。因此，对于任何出现晕厥的患者，都必须将心律失常视为潜在病因。对于那些被发现有折返性室性心律失常基础的晕厥患者（即心室功能障碍患者），治疗必须极为积极，因为他们猝死的近期风险很高，而保守治疗无效。栓塞性中风是房颤的常见后果。现在有几项随机试验表明，对于房颤患者，无论是否存在潜在的瓣膜性心脏病，只要有可能，都有必要使用小剂量华法林进行抗凝治疗。正在进行的研究正在评估阿司匹林预防栓塞事件的疗效。
