Escape appears

Introduction The so-called escape is that when the sinus node is less excitatory or arrested, the diastolic phase of the recessive pacemaker has a chance to reach the threshold potential, thereby causing excitement and driving the whole heart, called escape. Passive ectopic heart rhythm is a physiological protection mechanism, which does not require treatment itself. If the ventricular rate is too slow to produce symptoms or hypotension, it is necessary to increase the ventricular rate and give treatment.

Cause

The cause of escape:

Beat is common in organic heart disease involving the atria, such as rheumatic heart disease, chronic pulmonary heart disease, lung infection, emphysema, coronary heart disease, myocardial infarction, myocarditis, heart surgery, digitalis poisoning and Systemic infections, etc. Individual cases can be seen in people without structural heart disease, rarely seen in normal people. Accelerated atrial escape rhythm suggests a certain damage to the atrial muscle. However, it generally has no significant effect on hemodynamics and is not easy to develop into atrial fibrillation.

an examination

Related inspection

Electrocardiogram cardiac vascular ultrasound

Check diagnosis of escape:

1. The QRS wave frequency of slow and wide deformity can be seen on the electrocardiogram is 30-40 times/min. The degree of QRS wide and wide deformity is related to the position of the pacemaker. For example, if the pacemaker is above the atrioventricular fork, the degree of QRS wide and wide deformity is lighter, and the ventricular rate is more than 40 times/min; for example, the pacemaker is in the room. Below the bifurcation, the degree of QRS wide and large deformity is heavy, and the ventricular rate is often below 40 beats/min, and more often between 30 and 40 beats/min.

2, the ventricular escape cycle is mostly regular, but a few irregular.

3, ventricular escape rhythm, the atrium and ventricle are independent and excited, forming a complete atrioventricular separation.

Differential diagnosis

Easy to confuse symptoms:

1. The escape rhythm of the transition zone is associated with indoor differential conduction and ventricular escape rhythm. The ventricular rate of the escape rhythm with intermittent differential conduction in the junction area is 40-60 times/min, and the QRS wave is mildly deformed. It is a right bundle branch block diagram with a time-limited QRS wave width and large deformity. It is mostly single-phase or two-phase, with a time limit of >0.12 s. It can have a ventricular fusion wave.

2, ventricular escape rhythm and accelerated ventricular escape rhythm identification: the former ventricular rate of 20 ~ 40 times / min, is the passive heart rhythm of the atrioventricular junction; while the latter ventricular rate of 60 ~ 110 times / min, is Active heart rhythm of the ventricle.

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