问题 单项选择题

最容易发生房室传导阻滞的是()

A.急性前壁心肌梗死

B.急性前间壁心肌梗死

C.急性高侧壁心肌梗死

D.急性后壁心肌梗死

E.急性下壁心肌梗死

答案

参考答案:E

解析:心律失常是急性心梗早期死亡的重要原因之一。可将其分为快速心律失常和缓慢心律失常两类。快速心律失常中以室性心律失常最多,尤其是室性期前收缩,如室性期前收缩频发(每分钟5次以上),成对出现或呈短阵室性心动过速;多源性或落在前一心搏的易损期时(R在T波上),常为心室颤动先兆。AMI合并的一系列快速室性心律失常,反应了缺血心肌的电不稳定性,其发生系由于心肌梗死导致的不应性离散而易于发生折返所致。室上性心律失常包括房性早搏、室上性心动过速、房扑、房颤,其中房性早搏发生率较高可见于20%~25%的AMI患者。室上性心律失常被认为可能是心力衰竭的表现之一,或心房梗死及心电不稳定等原因所致。非阵发性交界区性心动过速常为一过性的,对血流动力学影响不大,有时可不处理。缓慢性心律失常包括窦性心动过缓、窦房阻滞、房室传导阻滞,多伴发于急性下壁心肌梗死,并伴有迷走神经张力增高的表现如恶心、呕吐、低血压,经一般处理,数目常可恢复。这种房室传导阻滞部位常在希氏束以上,常为可逆的。10%~20%的AMI患者合并有束支传导阻滞,严重时亦可引起三度房室传导阻滞,阻滞部位常位于希氏束以下,常为广泛前壁心肌梗死引起,多为不可逆的,可进展发生猝死。总之,前壁心梗常易引起快速性心律失常,下壁心梗易引起缓慢性心律失常

问答题

Chien, Linh and Trang formed a new limited liability company in January 2011. They decided that the company would specialise in selling high quality food products. Before the company was formed, Chien, Linh and Trang decided to enter into several transactions so that the company could commence trading as soon as the legal formalities relating to formation had been finalised.Chien was responsible for sourcing and selling seafood. In October 2010 he ordered 500 boxes of crab meat with the intention of selling it to the customers of the new company. He wrote to 50 prospective customers of the new company informing them that a maximum of three boxes of crab meat would be available for purchase by each customer at a price of 20 million dong per box. The remainder would be advertised for general sale.Linh was responsible for sourcing and selling herbs. She secured an agreement with a supplier of saffron, an expensive herb, and has already been told informally by five of her restaurant contacts that they would be prepared to pay 30 million dong per box for this product. She sent a box of saffron to each customer with an invoice for 30 million dong in November 2010.Trang agreed to take responsibility for sales of luxury chocolates. He had little knowledge of the products, but in December 2010 entered into an agreement with a Vietnamese trader to purchase 1,000 kilos of chocolates specially imported from Switzerland.Required:

(a) Explain whether legal binding contracts have been formed on behalf of the company by the actions of Chien, Linh and Trang, and the rights and obligations created by their actions. (7 marks)

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