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心慌、心跳一阵乱，要不要去做个心电图

2 条依据 · 约 550 字 · 出处逐条列出

要，而且心慌当时就去。房颤时血在心脏里淤住，结成块冲进脑子就是中风；按医生评估吃抗凝药，中风少约六成，死亡少约三成。阿司匹林只少约两成，代替不了。

这里不保证什么

没症状的人要不要专门去查，证据还不够；查出房颤之后要不要抗凝，请医生按评分定。吃上以后别自己停，拔牙、做手术前要先告诉医生。

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心慌、心跳乱就去做心电图，查出房颤请医生评估吃抗凝药防中风，别拿阿司匹林代替

房颤是心跳乱成一团，血在心里淤住容易结成血块，冲进脑子就是中风。按医生评估吃抗凝药，中风少约六成，死亡少约三成。阿司匹林这类药只少约两成，代替不了。2014 到 2016 年的调查里，中国高危房颤的人只有 6% 在吃抗凝药。

  • 心慌时尽快去做心电图，单导联 30 秒以上、12 导联 10 秒以上才够
  • 查出房颤请医生按评分评估要不要吃抗凝药，别自己吃阿司匹林
  • 吃上以后天天按点吃，别觉得没事就停；加止痛药前先问医生

坑有争议在筛查上：没症状的人要不要专门去查，证据不够；查出房颤之后吃抗凝药这一点没有争议。

成本：做一次心电图几十元。华法林很便宜，但要定期抽血调剂量。新型抗凝药不用常抽血，贵一些。难在没有症状也要天天吃，拔牙、做手术前要先告诉医生在吃抗凝药。第 1 节 · 不要早死

出处

Hart RG, Pearce LA, Aguilar MI. (2007). Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Annals of Internal Medicine, 146(12), 857-867. <https://doi.org/10.7326/0003-4819-146-12-200706190-00007>；Aguilar MI, Hart R. (2005). Oral anticoagulants for preventing stroke in patients with non-valvular atrial fibrillation and no previous history of stroke or transient ischemic attacks. Cochrane Database of Systematic Reviews, (3), CD001927. <https://doi.org/10.1002/14651858.CD001927.pub2>；Ruff CT, Giugliano RP, Braunwald E, et al. (2014). Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet, 383(9921), 955-962. <https://doi.org/10.1016/S0140-6736(13)62343-0>；Connolly SJ, Eikelboom J, Joyner C, et al. (2011). Apixaban in patients with atrial fibrillation. New England Journal of Medicine, 364(9), 806-817. <https://doi.org/10.1056/NEJMoa1007432>；Mant J, Hobbs FD, Fletcher K, et al. (2007). Warfarin versus aspirin for stroke prevention in an elderly community population with atrial fibrillation (the Birmingham Atrial Fibrillation Treatment of the Aged Study, BAFTA): a randomised controlled trial. Lancet, 370(9586), 493-503. <https://doi.org/10.1016/S0140-6736(07)61233-1>；Ma CS, Wu SL, Liu SW, Han YL, Chinese Society of Cardiology, et al. (2024). Chinese Guidelines for the Diagnosis and Management of Atrial Fibrillation. Journal of Geriatric Cardiology, 21(3), 251-314（中华医学会心血管病学分会等 2023 年《心房颤动诊断和治疗中国指南》的英文版）. <https://doi.org/10.26599/1671-5411.2024.03.009>；Joglar JA, Chung MK, Armbruster AL, et al. (2024). 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation. Circulation, 149(1), e1-e156. <https://doi.org/10.1161/CIR.0000000000001193>；Du X, Guo L, Xia S, et al. (2021). Atrial fibrillation prevalence, awareness and management in a nationwide survey of adults in China. Heart. <https://doi.org/10.1136/heartjnl-2020-317915>；Shi S, Tang Y, Zhao Q, et al. (2022). Prevalence and risk of atrial fibrillation in China: A national cross-sectional epidemiological study. Lancet Regional Health – Western Pacific, 23, 100439. <https://doi.org/10.1016/j.lanwpc.2022.100439>；US Preventive Services Task Force (2022). Screening for Atrial Fibrillation: US Preventive Services Task Force Recommendation Statement. JAMA, 327(4), 360-367. <https://doi.org/10.1001/jama.2021.23732>；Svennberg E, Friberg L, Frykman V, et al. (2021). Clinical outcomes in systematic screening for atrial fibrillation (STROKESTOP): a multicentre, parallel group, unmasked, randomised controlled trial. Lancet, 398(10310), 1498-1506. <https://doi.org/10.1016/S0140-6736(21)01637-8>；Svendsen JH, Diederichsen SZ, Højberg S, et al. (2021). Implantable loop recorder detection of atrial fibrillation to prevent stroke (The LOOP Study): a randomised controlled trial. Lancet, 398(10310), 1507-1516. <https://doi.org/10.1016/S0140-6736(21)01698-6>

量血压，高了就吃药降到达标

高压每降 10 mmHg，出大的心血管毛病的概率降两成，中风降 27%。心衰降 28%，死亡概率降 13%。中国 35 到 75 岁的人里，44.7% 有高血压，真正控制住的只有 7.2%。

  • 买一个上臂式电子血压计，量之前先坐一会儿，别刚上楼就量
  • 连着量七天，早晚各一次，把两个数记下来
  • 带着记录去医院，医生说吃药就按点吃，降下来也别自己停

坑降到 130 还是 140 算达标，学界还有讨论；把已经高起来的血压降下来这件事本身没有争议。

成本：电子血压计 100 到 200 元。量一次 1 分钟。降压药多数每月几元到几十元。难的地方是没症状也要接着吃。第 1 节 · 不要早死

出处

Ettehad D 等 (2016). Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet. <https://doi.org/10.1016/S0140-6736(15)01225-8> ; Lu J 等 (2017). Prevalence, awareness, treatment, and control of hypertension in China (China PEACE Million Persons Project). Lancet. <https://doi.org/10.1016/S0140-6736(17)32478-9>

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