这位患有心的病人心律不整吗?
Paaladinesh Thavendiranathan1, Akshay Bagai, Clarence Khoo
1Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
JAMA
|November 19, 2009
概括
对心的临床检查往往不足以排除心律失常. 长时间的心电图监测通常是必要的,以准确诊断患有反复心的患者的心律不整.
科学领域:
- 心脏病学 心脏病学
- 诊断的准确性 诊断的准确性
- 临床医学 临床医学
背景情况:
- 心是患者向全科医生提出的常见投诉.
- 区分良性病因与严重的心律不整可能是具有挑战性的.
- 临床检查可能提供诊断线索,但需要仔细解释.
研究的目的:
- 系统地审查患者病史,体检和心脏检测的诊断准确性,以识别患有心的患者心律失常.
- 评估临床特征在诊断或排除显著心律失常时的可靠性.
主要方法:
- 在MEDLINE和EMBASE数据库中对1950年至2009年间发表的英语文章进行了全面的文献搜索.
- 选择了比较临床特征和诊断测试与心律失常的参考标准的研究.
- 包括七项研究用于准确性分析和16项用于诊断产量分析,数据被提取并由多个审查员评估质量.
主要成果:
- 心脏病史,睡眠或工作期间的心,部脉稍微增加了心律失常的可能性.
- 曾经有过恐慌症或短暂的心,会降低心律失常的可能性.
- 常规的部快速跳动的感觉强烈地表明心房节点重入心力衰竭,但它的缺席并不排除它. 循环监视器在心律失常检测方面提供了最高的诊断产量 (34%-84%).
结论:
- 虽然特定的部感觉可以暗示某些心律失常,如心房节点重入心律失常,但仅仅临床检查不足以排除大多数患者的显著心律失常.
- 反复发作的心往往需要长时间的心电图监测与症状节律相关性,以准确诊断.
- 电心电图监测的诊断产量因监测期间的模式,持续时间和症状发生而异.
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