Insulin stimulated glucose uptake is decreased in NIDDM

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• ??????
• ????????,??,???,??
• ?????????,????(??,????,??)
• ????? (??,????,??)
• ???????(??,????,??),
• ?????(?????)
• ??????
• ??????????
• ???????,????,????,
• ????(?,?????????)
• ??????????????

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??????????? 1.?? arrest 2.??
escape 3.???????????? 4.?? normal 5.????
tachycardia 6.?? flutter 7.?? fibrilation
3
????????? ?????? ?????
abnormal automatic activity ????
triggered activity ???
afterdepolarization ?????? ?? reentrant
activity
4
Vaughan Williams????????? IA
??????(????????) ???, ??????, ????? IB
??????(????????) ????, ???, ???? IC
??????(???????????????) ???(????), ????,
??? II ß????? ???(????) III ??????????
???(???), ????, ??? IV ???? ???
5
?????????? ?. ??????????????
???,??,?????,???? ?. ????????????(Pacing)
?????????? ????VVI,AAI,VVIR,DDD
?????,????(ICD) ?. ??????(???????)
???? ??????
6
????????(sick sinus syndrome) ????
???? ????
????????? ??,???? ?????????,I0AVB ??????
????????? ?-????
7
????(atrial premature beat) ??????? ??????? ????

8
????????? ??? ???
???? ????? ?????
????? ?????? ?????? ?????
??????? ?????
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??2 40?,??,???10??????????????? ??,????????,???
?????????? ????????????,??????????? P
72?/?,BP110/70mmHg,???,????,??? ???,????,????,??72
?/?,??,???, ?????ECG? ???????????????? ?????,??
???? ??????(???)?????? ???????????????? ?????????
???? ??????????????
10
PSVT?? (???????) 1. ???? 2.?????? 3.Valsalv
a?? 4.?????? 5.????? 6.??????
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PSVT??
(?????) 1.??6-12mg iv 2.???5-10 12mg
iv (???CHF,?????QRS????) 3.?????? 0.2-0.4mg
iv (??CHF,????????) 4.ß????? 5.IA,IC?III??
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??1 65?,??,????????????????????? ???,???,?????,?
???????,??? ??P38?/?,Bp130/80mmHg,???,????,?? ???
?,?????,????,????,??38?/?, ???,??????,?????,????,?
??? ?????????????,?????? ?????????(???)??????
???????????????????? ???????????
?????????? ????1-2?,????????140-160?/?,???
?????
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??????? 1.????????????? 2.??????????
???? 3.???????? ß?????
??? 4.??IA,IC??????????
III??CHF,???
14
???? ????? ????? ????? ???? ????
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???????
(?????) 1.?????, ß?????,???? 2.??CHF,??? 3.????
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??????? (??) 1.?????????,??CHF,???
2.????IA?????,??
IC????????? III???
17
??????????? ????(????) ???? ??? ??? ???? ???? ???
? ???? ???? ?????? R on T ??
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????? (risk VPB) AMI??????? 1.???gt5?/? 2.??? 3.
????? 4.R on T
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??3 55?,??,???????2-3??????????? ?????????ST???
,T ????????? ????????????,???????????? ????????,??
????? ??P108?/?,BP170/95mmHg,?????,?? ??,????,???
?,???????????, ??108?/?,????? ?????,?????? ?????,
?????????? ????? ????????????? ?????????????? ????
???????????????
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?????? ????? ???? ????
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???????? ?????lt30? ??????gt30? ????? ?????(????
????) ?????
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??????? 1. ?ß?????,??????,???????
?????SD???,?????????? 2. ?????????VT,??????,?
?? 3. ???VT,???????,???? 4. ?????????VT,???
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?????? 1. ????????,??I.v.
lidocaine, procainamide,quinidine, sotalol,
propafenone 2. ????? amiodarone I.v.???????? 3.
?????,??????????,???? 4. ?????,??,CHF,???,??????
???????????? 5. ???VT,????,????????
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?????? 1. ??????? 2. ??
IA,IB,IC, II, III????? 3. Verapamil????????VT
?? 4. ????? ICD 5. ???? 6.????
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?????????(???VT) 1.
??AMI???,????,???,? ??,????? 2. ????,??????? 3.
??????? A ??????? B ????????VT C VT??????? R
on T D HR?????? E???? 4.???VT,????atropine???
??
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???????(torsades de pointes)
?? ???Q-T??????? ?????(??,??,???) ??(IA,IC??,????
????????) ???? ????(????? III 0AVB)
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???????(torsades de pointes) ?? 1.
??????? 2. ?? I.v. ???,???? IB??? 3. ???atropine,
isoproterenol 4.???? IA,IC,III???,??Q-T???? 5.???Q
-T????, ??ß??????????? 6.????,??????????
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??????? ?AMI?????,??????,???? ?????,??????20-30,
??? ??????????,??200-300W
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??4 ?,50???1???????????????,??? ???????????,???
???1??????? ????,??????????,????????? ?????1?(?5??
??)????????? ?????(?1,?2) ?????? ?????,??????????
????? ????????????? ?????????
????????????????
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????????(atriol-ventricular block) I0
AVB II0AVB II0I AVB(type Mobitz I,wenckbach
syndrome) II0II AVB(type Mobitz II) III0 AVB
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AVB ?? 1.????? I0AVB, II0
I AVB 2.???(AMI,????),???,???,
???,???(?????????) 3.???(???,????) 4.???? 5.???? 6
.????? 7.Lyme?, Chagas?????? 8.Lev?,
Lenegre?????????? 9.????? 10.????
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I0AVB ECG
P-Rgt0.2s QRSlt0.12??????????,
???His? QRSgt0.12??????????His?,
??????
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II0AVB I ? P-R????,??P???,R-R??
?? QRSlt0.12??????????,
????His? QRSgt0.12??????????His?,
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II0AVB I I? P-R??,????P??? QRSlt
0.12??????????,
?His? QRSgt0.12?????His? Atropine???,????????His??
?? Atropine???,??????????????
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III0AVB
P-P?,R-R?,P-R??,?????? P?????R??? ?????????????
????????????? ?????His????,??40-60?/?,
QRS??,???? ???????,??lt40?/?, QRS??
?????
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AVB?? 1. ???? 2. I0AVB,II0
I?AVB?HR?????? 3. HR?,??atropine, isoproterenol
atropine ????????? isoproterenol????????,AMI??
4.?????????
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